Organization
ATLANTIC GYNECOLOGIC ON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA ANN MENDUM (PRACTICE MANAGER)
(732) 280-5464
Entity
Organization
Contact information
Practice address
3349 HWY 138, BLDG B SUITE F, WALL TOWNSHIP, NJ 07719-9671
(732) 280-5464
(732) 280-5443
Mailing address
3349 HWY 138, BLDG B SUITE F, WALL TOWNSHIP, NJ 07719-9671
(732) 280-5464
(732) 280-5443
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
MB48253
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6734502
—
NJ
01
—
CG6895
RAIL ROAD MEDICARE
NJ
Enumeration date
07/07/2005
Last updated
01/09/2008
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