Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2014-05-05
- Last updated
- 2021-07-24
Specialties
Licenses
- License NJ
- 25MA10184800
Location
- Practice location
- 1673 HIGHWAY 88
- City
- BRICK NJ
- Postal code
- 087243071
- Phone
- 732-458-2000
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.