Provider Demographics
NPI:1588908784
Name:JERSEY SHORE GERIATRICS INC
Entity type:Organization
Organization Name:JERSEY SHORE GERIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-866-9922
Mailing Address - Street 1:100 CRAIG RD STE 205A
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8731
Mailing Address - Country:US
Mailing Address - Phone:732-866-9922
Mailing Address - Fax:732-866-9970
Practice Address - Street 1:100 CRAIG RD STE 205A
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8731
Practice Address - Country:US
Practice Address - Phone:732-866-9922
Practice Address - Fax:732-866-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty