Organization
DR JM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY MABAGOS (OWNER)
(732) 279-6537
Entity
Organization
Contact information
Practice address
525 ROUTE 70 EAST, SUITE 1-C, BRICK, NJ 08723-4022
(732) 279-6537
(732) 279-6542
Mailing address
525 ROUTE 70 EAST, SUITE 1-C, BRICK, NJ 08723-4022
(732) 279-6537
(732) 279-6542
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
25MA06682500
NJ
302R00000X
Health Maintenance Organization
25MA06682500
NJ
305R00000X
Preferred Provider Organization
25MA06682500
NJ
305S00000X
Point of Service
25MA06682500
NJ
Other
Enumeration date
01/13/2010
Last updated
01/13/2010
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