Provider Demographics
NPI:1750564209
Name:JERSEY COAST FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:JERSEY COAST FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRONHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-8000
Mailing Address - Street 1:495 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7778
Mailing Address - Country:US
Mailing Address - Phone:732-458-8000
Mailing Address - Fax:732-458-8020
Practice Address - Street 1:495 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7778
Practice Address - Country:US
Practice Address - Phone:732-458-8000
Practice Address - Fax:732-458-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty