Provider Demographics
NPI:1467642736
Name:AFFILIATED MEDICAL SERVICE
Entity type:Organization
Organization Name:AFFILIATED MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-264-7222
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-0027
Mailing Address - Country:US
Mailing Address - Phone:732-264-7222
Mailing Address - Fax:732-264-4143
Practice Address - Street 1:25 E FRONT ST
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1562
Practice Address - Country:US
Practice Address - Phone:732-264-7222
Practice Address - Fax:732-264-4143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIFE COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty