Organization
PEDIATRIC AND ADOLESCENT MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAUREEN E KINGSLEY (OFFICE MNG)
(732) 229-4540
Entity
Organization
Contact information
Practice address
223 MONMOUTH RD, WEST LONG BRANCH, NJ 07764-1029
(732) 229-4540
(732) 229-8689
Mailing address
223 MONMOUTH RD, WEST LONG BRANCH, NJ 07764-1029
(732) 229-4540
(732) 229-8689
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
MA040400
NJ
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MA37398
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0238201
—
NJ
05
—
2003201
—
NJ
Enumeration date
01/12/2007
Last updated
08/22/2020
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