| Organization Name: | JERSEY SHORE REJUVINATION CENTER, LLC |
| NPI Number: | 1114300225 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GABRIELE P JASPER (MANAGING MEMBER) |
| Mailing Address: | 74 Brick Blvd Ste 124 Brick |
| State: | NJ US |
| Postal Code: | 087237984 |
| Phone Number: | 7322622809 |
| Fax Number: | 7322620400 |
| NPI Enumeration Date: | 07/07/2015 |
| NPI Last Update Date: | 07/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MA06352100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |