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Organization
NORTHERN MONMOUTH COUNTY MEDICAL
Active
Organization
NORTHERN MONMOUTH COUNTY MEDICAL
Active
Parent organization
MEDVANTX, INC.
Other names
Northern Monmouth County Medical Associates-Matawan Medical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
213 MAIN ST, MATAWAN, NJ 07747-3221
(732) 566-2363
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MB08392800
NJ
Other
Enumeration date
10/02/2013
Last updated
09/10/2014
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