Basic Information
| Provider Information | |||||||||
| NPI: | 1053494203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHPOINT MEDICAL GROUP OF ASBURY PARK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 W 27TH ST | ||||||||
| Address2: | 11TH FLOOR SOUTH | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100016216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125632497 | ||||||||
| FaxNumber: | 2125630605 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 MAIN ST | ||||||||
| Address2: | STE A | ||||||||
| City: | ASBURY PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077125967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327747506 | ||||||||
| FaxNumber: | 7327745451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 04/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | LALLEMAND | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7327747506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.