NPIMap

Organization Active NPI

Atlantic Gynecologic on

  • Gynecologic Oncology Physician
  • Wall Township, NJ
National Provider Identifier
1902804693
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
MB48253 Issued in NJ
Legal business name
ATLANTIC GYNECOLOGIC ON
Practice address
3349 Hwy 138
BLDG B Suite F
Wall Township, NJ 07719-9671
Phone
(732) 280-5464
Fax
(732) 280-5443
NPI assigned
Jul 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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

Authorized official

Name
Mrs. Lisa Ann Mendum
Title
Practice Manager
Phone
(732) 280-5464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VX0201X MB48253 NJ Primary

Addresses

Primary practice location

3349 Hwy 138
BLDG B Suite F
Wall Township, NJ 07719-9671

Mailing address

3349 Hwy 138
BLDG B Suite F
Wall Township, NJ 07719-9671
Phone (732) 280-5464

Other identifiers 2

IdentifierTypeStateIssuer
6734502MedicaidNJ
CG6895OtherNJRAIL ROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

1540 Highway 38
Ste 205
Wall, NJ 07719
Phone (732) 280-5464

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1902804693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3349 HWY 138",
            "address_2": "BLDG B SUITE F",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199671",
            "telephone_number": "732-280-5464",
            "fax_number": "732-280-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3349 HWY 138",
            "address_2": "BLDG B SUITE F",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199671",
            "telephone_number": "732-280-5464",
            "fax_number": "732-280-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC GYNECOLOGIC ON",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "MENDUM",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "732-280-5464",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NJ",
            "license": "MB48253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6734502",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CG6895",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wall Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; 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.