Provider Demographics
NPI:1962635532
Name:MONETTE M. TRESVALLES, MD, LLC
Entity Type:Organization
Organization Name:MONETTE M. TRESVALLES, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRESVALLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-716-1000
Mailing Address - Street 1:1749 ROLLING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1005
Mailing Address - Country:US
Mailing Address - Phone:732-716-1000
Mailing Address - Fax:732-716-1900
Practice Address - Street 1:65 LACEY RD STE D
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2985
Practice Address - Country:US
Practice Address - Phone:732-716-1000
Practice Address - Fax:732-716-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66534261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7673400Medicaid
G81996Medicare UPIN
018288Medicare PIN