Provider Demographics
NPI:1487705786
Name:MARATHON MEDICAL ASSOC.,P.A.
Entity type:Organization
Organization Name:MARATHON MEDICAL ASSOC.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-653-0088
Mailing Address - Street 1:52 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2380
Mailing Address - Country:US
Mailing Address - Phone:609-653-0088
Mailing Address - Fax:609-653-8941
Practice Address - Street 1:52 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2380
Practice Address - Country:US
Practice Address - Phone:609-653-0088
Practice Address - Fax:609-653-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
029794Medicare ID - Type UnspecifiedMEDICARE GROUP #