Provider Demographics
NPI:1962586396
Name:TRESVALLES, MONETTE M (MD)
Entity type:Individual
Prefix:MRS
First Name:MONETTE
Middle Name:M
Last Name:TRESVALLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 ROLLING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-716-1000
Mailing Address - Fax:732-716-1900
Practice Address - Street 1:65 D LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-716-1000
Practice Address - Fax:732-716-1900
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7673400Medicaid
G81996Medicare UPIN
NJ7673400Medicaid