James K Heacock MD LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

MA 34928 Issued in NJ

Legal business name

JAMES K HEACOCK MD LLC

Practice address

1640 Route 88
Suite 203
Brick, NJ 08724-3036

Phone

(732) 458-7777

Fax

(732) 458-6741

NPI assigned

Jan 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Kipp Heacock, MD

Title

Owner

Phone

(732) 458-7777

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235296393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 ROUTE 88",
            "address_2": "SUITE 203",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087243036",
            "telephone_number": "732-458-7777",
            "fax_number": "732-458-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 ROUTE 88",
            "address_2": "SUITE 203",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087243036",
            "telephone_number": "732-458-7777",
            "fax_number": "732-458-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES K HEACOCK MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEACOCK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "KIPP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-458-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NJ",
            "license": "MA 34928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4745809",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohammad Q Jafri, DO
• Keshani Jain, MD
• Vikalp Jain, MD
• James E Lynch LLC
• James E. Rotolo, M.D., F.a.C.S., P.a.
• James Kish PT
• Stacie Jandik, DNP, FNP, APN
• Larisa Janoczkin, PHARMD
• Jarahian Medical LLC
• George Jarahian, MD

• Health Service Clinic/Center in Brick, NJ
• Providers in Brick, NJ by specialty
• Health Service Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.