NPIMap

Organization Active NPI

Jersey Shore Monmouth Family Medicine Group PC

  • Non-Pharmacy Dispensing Site
  • Jackson, NJ
National Provider Identifier
1679976435
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA08265400 Issued in NJ
Legal business name
JERSEY SHORE MONMOUTH FAMILY MEDICINE GROUP PC
Practice address
27 S Cooks Bridge Rd
Suite 27
Jackson, NJ 08527-2524
Phone
(732) 987-5545
NPI assigned
Oct 7, 2014
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA08265400 NJ Primary

Addresses

Primary practice location

27 S Cooks Bridge Rd
Suite 27
Jackson, NJ 08527-2524

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Meridian JS Monmouth Family Medical Group at Jackson Village Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jersey Shore Monmouth Family Medicine Group PC3 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1679976435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 S COOKS BRIDGE RD",
            "address_2": "SUITE 27",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085272524",
            "telephone_number": "732-987-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY SHORE MONMOUTH FAMILY MEDICINE GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA08265400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian JS Monmouth Family Medical Group at Jackson Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.