NPIMap

Organization Active NPI

Jackson Family Practice LLC

  • Family Medicine Physician
  • Freehold, NJ
National Provider Identifier
1922244060
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB05981900 Issued in NJ
Legal business name
JACKSON FAMILY PRACTICE LLC
Practice address
80 Scenic Dr
Suite 6
Freehold, NJ 07728-5210
Phone
(732) 683-0010
NPI assigned
Dec 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Miah Kim, DONPI 1720053838
Title
Owner
Phone
(732) 683-0010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 25MB05981900 NJ Primary

Addresses

Primary practice location

80 Scenic Dr
Suite 6
Freehold, NJ 07728-5210

Mailing address

80 Scenic Dr
Suite 6
Freehold, NJ 07728-5210
Phone (732) 683-0010

National Provider Directory

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": "1229644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1922244060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 SCENIC DR",
            "address_2": "SUITE 6",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285210",
            "telephone_number": "732-683-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SCENIC DR",
            "address_2": "SUITE 6",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285210",
            "telephone_number": "732-683-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-19",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MIAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-683-0010",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB05981900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.