NPIMap

Organization Active NPI

Avenel Iselin Medical Group, LLC

Doing business as Avenel Iselin Medical Group

  • Non-Pharmacy Dispensing Site
  • Iselin, NJ
National Provider Identifier
1669717864
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA05991500 Issued in NJ
Legal business name
AVENEL ISELIN MEDICAL GROUP, LLC
Doing business as
Avenel Iselin Medical Group
Practice address
400 Gill LN
1
Iselin, NJ 08830-3059
Phone
(732) 404-1580
NPI assigned
Nov 29, 2012
Last updated
Oct 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Authorized official

Name
Kenny Heine
Title
VP Ops
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA05991500 NJ Primary

Addresses

Primary practice location

400 Gill LN
1
Iselin, NJ 08830-3059

Mailing address

5626 Oberlin Dr
110
San Diego, CA 92121-1705

Other names 1

  • AVENEL ISELIN MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avenel Iselin Med Group PA2 organizations share this tax ID, including this one
Part of
Hamot Health Foundation

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1669717864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GILL LN",
            "address_2": "1",
            "city": "ISELIN",
            "state": "NJ",
            "postal_code": "088303059",
            "telephone_number": "732-404-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVENEL ISELIN MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2012-11-29",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA05991500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVENEL ISELIN MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Iselin, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.