NPIMap

Organization Active NPI

Seacoast Spine & Sport Medical Institute

  • Interventional Pain Medicine Physician
  • Eatontown, NJ
National Provider Identifier
1467031096
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
SEACOAST SPINE & SPORT MEDICAL INSTITUTE
Practice address
40 Corbett Way
Eatontown, NJ 07724-2263
Phone
(732) 955-0655
NPI assigned
Apr 2, 2021
Last updated
Apr 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Authorized official

Name
Dr. Khanh Nguyen, MDNPI 1235143892
Title
President
Phone
(732) 955-0655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

40 Corbett Way
Eatontown, NJ 07724-2263

Mailing address

40 Corbett Way
Eatontown, NJ 07724-2263
Phone (732) 955-0655

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617321600000",
    "number": "1467031096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242263",
            "telephone_number": "732-955-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CORBETT WAY",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242263",
            "telephone_number": "732-955-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEACOAST SPINE & SPORT MEDICAL INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-02",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KHANH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-955-0655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.