Basic Information
Provider Information | |||||||||
NPI: | 1497900781 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MONMOUTH MEDICAL CENTER INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 300 2ND AVE | ||||||||
Address2: |   | ||||||||
City: | LONG BRANCH | ||||||||
State: | NJ | ||||||||
PostalCode: | 077406303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7329235000 | ||||||||
FaxNumber: | 7329236294 | ||||||||
Practice Location | |||||||||
Address1: | 300 2ND AVE | ||||||||
Address2: |   | ||||||||
City: | LONG BRANCH | ||||||||
State: | NJ | ||||||||
PostalCode: | 077406303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7329235000 | ||||||||
FaxNumber: | 7329236294 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/01/2008 | ||||||||
LastUpdateDate: | 12/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CARNEY | ||||||||
AuthorizedOfficialFirstName: | ERIC | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 7329237507 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BARNABAS HEALTH INC | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 11304 | NJ | Y |   | Hospital Units | Psychiatric Unit |   |
ID Information
ID | Type | State | Issuer | Description | 3675807 | 05 | NJ |   | MEDICAID |