1134165210 NPI number — MID ATLANTIC GERIATRIC ASSOCIATES OCEAN, P.A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134165210 NPI number — MID ATLANTIC GERIATRIC ASSOCIATES OCEAN, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID ATLANTIC GERIATRIC ASSOCIATES OCEAN, P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134165210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MUSKET LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-2447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-996-1800
Provider Business Mailing Address Fax Number:
732-728-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MUSKET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-996-1800
Provider Business Practice Location Address Fax Number:
732-728-1954
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHUA-HAIM
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
732-657-6100

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134165210 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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