Basic Information
| Provider Information | |||||||||
| NPI: | 1669791869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONMOUTH FAMILY HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077407027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329237100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 PAVILION AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329237100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 12/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNCAN | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7324132020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 23168 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0237426 | 05 | NJ | MEDICAID |