# MMC PROVIDER SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932647872
- **Authorized official:** JACQUELINE MINTZ (DIR. FINANCE)
- **Authorized official phone:** (732) 423-7497

## Contact information

- **Practice address:** 300 2ND AVE, LONG BRANCH, NJ 07740-6303
- **Practice address phone:** (732) 557-8000
- **Mailing address:** 95 OLD SHORT HILLS RD, WEST ORANGE, NJ 07052-1008
- **Mailing address phone:** (732) 423-7497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | — | Yes |
| 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