Organization Active NPI

Petronilo L Seares Jr MD LLC

  • Internal Medicine Physician
  • Brick Township, NJ
National Provider Identifier
1750545695
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PETRONILO L SEARES JR MD LLC
Practice address
35 Beaverson Blvd BLDG 7 Suite B
Brick Township, NJ 08723-7860
Phone
(732) 262-2400
Fax
(732) 262-3883
NPI assigned
Jul 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

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

Authorized official

Name
Dr. Petronilo L Seares Jr., MDNPI 1831135110
Title
President
Phone
(732) 262-2400

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

35 Beaverson Blvd BLDG 7 Suite B
Brick Township, NJ 08723-7860

Mailing address

35 Beaverson Blvd BLDG 7 Suite B
Brick Township, NJ 08723-7860
Phone (732) 262-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080916000021 NJ Part B Supplier - Clinic/Group Practice 7810064938 Receives reassigned benefits from 2 practitioners
Practice locations: Brick, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0960319Petronilo L Seares Jr MD35 Beaverson Blvd BLDG 7 Suite B, Brick, NJ 08723Certificate of waiverMay 5, 2027

National Provider Directory

National Provider Directory

Locations

35 Beaverson Blvd
Ste 7B
Brick, NJ 08723
Phone (732) 262-2400

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1750545695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 BEAVERSON BLVD BLDG 7 SUITE B",
            "city": "BRICK TOWNSHIP",
            "state": "NJ",
            "postal_code": "087237860",
            "telephone_number": "732-262-2400",
            "fax_number": "732-262-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 BEAVERSON BLVD BLDG 7 SUITE B",
            "city": "BRICK TOWNSHIP",
            "state": "NJ",
            "postal_code": "087237860",
            "telephone_number": "732-262-2400",
            "fax_number": "732-262-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRONILO L SEARES JR MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "SEARES",
        "authorized_official_first_name": "PETRONILO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-262-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.