Provider Demographics
NPI:1922279710
Name:MONMOUTH INFECTIOUS DISEASE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MONMOUTH INFECTIOUS DISEASE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-819-2920
Mailing Address - Street 1:223 DRUM POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6311
Mailing Address - Country:US
Mailing Address - Phone:718-819-2920
Mailing Address - Fax:718-307-6434
Practice Address - Street 1:223 DRUM POINT RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6311
Practice Address - Country:US
Practice Address - Phone:718-819-2920
Practice Address - Fax:718-307-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07808400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty