Provider Demographics
NPI:1801891437
Name:BEAL, JEFFREY M (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:BEAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-2016
Mailing Address - Country:US
Mailing Address - Phone:732-776-8473
Mailing Address - Fax:732-869-9160
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-2016
Practice Address - Country:US
Practice Address - Phone:732-776-8473
Practice Address - Fax:732-869-9160
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA48763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2142708Medicaid
NJ2142708Medicaid
NJ536580UWDMedicare PIN