| Organization Name: | EARLE NAVAL HEALTH CLINIC |
| NPI Number: | 1477750990 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARCIA DICKSON (SUPERVISOR REVENUE COLLECTION) |
| Mailing Address: | 201 State Route 34 S Colts Neck |
| State: | NJ US |
| Postal Code: | 077221902 |
| Phone Number: | 7328662300 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2007 |
| NPI Last Update Date: | 07/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1102X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military Outpatient Operational (Transportable) Component |
| Taxonomy Definition: | |