Organization
JAMES K HEACOCK MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES KIPP HEACOCK MD (OWNER)
(732) 458-7777
Entity
Organization
Contact information
Practice address
1640 ROUTE 88, SUITE 203, BRICK, NJ 08724-3036
(732) 458-7777
(732) 458-6741
Mailing address
1640 ROUTE 88, SUITE 203, BRICK, NJ 08724-3036
(732) 458-7777
(732) 458-6741
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MA 34928
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4745809
—
NJ
Enumeration date
01/01/2007
Last updated
08/22/2020
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