Provider Demographics
NPI:1992900948
Name:MONMOUTH MEDICAL CENTER
Entity type:Organization
Organization Name:MONMOUTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-923-6537
Mailing Address - Street 1:6 ALTON WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2858
Mailing Address - Country:US
Mailing Address - Phone:908-753-8793
Mailing Address - Fax:
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:MONMOUTH MEDICAL CENTER
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6537
Practice Address - Fax:732-923-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty