| Jackson Family Practice Llc | |
|
80 Scenic Dr Suite 6 Freehold NJ 07728-5210 | |
| (732) 683-0010 | |
| Not Available |
| Full Name | Jackson Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 80 Scenic Dr, Freehold, New Jersey |
| Authorized Official Name and Position | Miah Kim (OWNER) |
| Authorized Official Contact | 7326830010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Family Practice Llc 80 Scenic Dr Suite 6 Freehold NJ 07728-5210 Ph: (732) 683-0010 | Jackson Family Practice Llc 80 Scenic Dr Suite 6 Freehold NJ 07728-5210 Ph: (732) 683-0010 |
| NPI Number | 1922244060 |
|---|---|
| Provider Enumeration Date | 12/19/2008 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 2062577349 |
|---|---|
| Medicare Enrollment ID | O20090305000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922244060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25MB05981900 (New Jersey) | Primary |
| Provider Name | Miah Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720053838 PECOS PAC ID: 2365507647 Enrollment ID: I20090220000185 |
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