Provider Demographics
NPI:1053494203
Name:HEALTHPOINT MEDICAL GROUP OF ASBURY PARK, LLC
Entity type:Organization
Organization Name:HEALTHPOINT MEDICAL GROUP OF ASBURY PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLEMAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-774-7506
Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2497
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:908 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5967
Practice Address - Country:US
Practice Address - Phone:732-774-7506
Practice Address - Fax:732-774-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093922Medicare PIN