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Organization
MMC PROVIDER SERVICES
Active
Organization
MMC PROVIDER SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE MINTZ (DIR. FINANCE)
(732) 423-7497
Entity
Organization
Contact information
Practice address
300 2ND AVE, LONG BRANCH, NJ 07740-6303
(732) 557-8000
Mailing address
95 OLD SHORT HILLS RD, WEST ORANGE, NJ 07052-1008
(732) 423-7497
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
NULL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Enumeration date
02/10/2017
Last updated
07/29/2021
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