Monmouth Medical Center Faculty Practice Plan, Inc.
Organization Active NPI Internal Medicine Physician · Long Branch, NJ
NPI 1023064441 · NPPES record last updated Mar 9, 2012
Key facts
- NPI
- 1023064441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MONMOUTH MEDICAL CENTER FACULTY PRACTICE PLAN, INC.
- Practice address
- 300 2ND Ave
Long Branch, NJ 07740-6303 - Phone
- (732) 571-0025
- Fax
- (732) 571-0400
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Tanya Kenney
- Title
- Mmcfpp Manager
- Phone
- (732) 923-6281
Practitioners 5
-
Shira Goldberg, MD
-
Luanne Petrie, R.D.
-
Kirby Douglas Rekedal, M.D.
-
Gweneth Wagnon, N.P.
-
Nicole Eckman, R.D., C.D.E.
National Provider Directory
Locations
255 3rd Ave
Ste 10
Long Branch, NJ 07740
Phone (732) 923-6060
307 3rd Ave
Long Branch, NJ 07740
Phone (732) 923-7709
279 3rd Ave
Ste 103
Long Branch, NJ 07740
Phone (732) 483-0080
65 Lacey Rd
Ste G
Whiting, NJ 08759
Phone (732) 716-0300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Adolescent Medicine (Internal Medicine) Physician |
207RA0000X | |||
| Geriatric Medicine (Internal Medicine) Physician |
207RG0300X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Maternal & Fetal Medicine Physician |
207VM0101X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Diagnostic Radiology Physician |
2085R0202X | |||
| Surgery Physician |
208600000X |
Addresses
Primary practice location
300 2ND Ave
Long Branch, NJ 07740-6303
Mailing address
PO Box 8000
Dept 601
Buffalo, NY 14267-0002
Phone (866) 295-0041
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6441301 | Medicaid | NJ |
Other providers in Long Branch, NJ
- Monmouth Medical Center
- Monmouth Medical Center
- Monmouth Medical Center
- Monmouth Medical Center
- Monmouth Medical Center
- Monmouth Medical Center Inc
- Monmouth Medical Center Inc
- Monmouth Medical Electrocardiology
- Monmouth Medical Imaging, PA
- Monmouth Neonatal Group, PA
All providers in Long Branch, NJ · Internal Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.