Provider Demographics
NPI:1689992968
Name:CHRISTOPHER G. PIERSON, M.D., LLC
Entity Type:Organization
Organization Name:CHRISTOPHER G. PIERSON, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-923-9603
Mailing Address - Street 1:241 MONMOUTH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1177
Mailing Address - Country:US
Mailing Address - Phone:732-923-9603
Mailing Address - Fax:732-923-9096
Practice Address - Street 1:241 MONMOUTH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1177
Practice Address - Country:US
Practice Address - Phone:732-923-9603
Practice Address - Fax:732-923-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65534174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7500807Medicaid
NJ1396701900OtherINDIVIDUAL NPI
NJ7500807Medicaid