Provider Demographics
NPI:1043465255
Name:LONG BEACH TOWNSHIP
Entity type:Organization
Organization Name:LONG BEACH TOWNSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRUPINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, HO
Authorized Official - Phone:609-492-1212
Mailing Address - Street 1:2119 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-4356
Mailing Address - Country:US
Mailing Address - Phone:609-492-1212
Mailing Address - Fax:609-492-9215
Practice Address - Street 1:2119 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SHIP BOTTOM
Practice Address - State:NJ
Practice Address - Zip Code:08008-4356
Practice Address - Country:US
Practice Address - Phone:609-492-1212
Practice Address - Fax:609-492-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ761864Medicare PIN