Provider Demographics
NPI:1720365422
Name:DR JOHN J NEVINS LLC
Entity Type:Organization
Organization Name:DR JOHN J NEVINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-387-8520
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-0235
Mailing Address - Country:US
Mailing Address - Phone:732-387-8520
Mailing Address - Fax:732-387-8649
Practice Address - Street 1:6 AUER CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5828
Practice Address - Country:US
Practice Address - Phone:732-387-8520
Practice Address - Fax:732-387-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0604801Medicaid
NJ0604801Medicaid