Provider Demographics
NPI:1598879041
Name:MONMOUTH OCEAN PULMONARY MEDICINE, LLC
Entity Type:Organization
Organization Name:MONMOUTH OCEAN PULMONARY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCCP
Authorized Official - Phone:732-577-6331
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 160, CN 5050
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-577-0600
Mailing Address - Fax:732-577-6332
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 160, CN 5050
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-577-0600
Practice Address - Fax:732-577-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46946OtherAETNA
NYWK037OtherEMPIRE BCBS
NJ3428800Medicaid
NJ=========OtherTAX IDENTIFICATION NUMBER
NYWK037OtherEMPIRE BCBS
NJ064860Medicare ID - Type UnspecifiedGROUP NUMBER