Provider Demographics
NPI:1144548165
Name:JANLINN HEALTHCARE LLC
Entity type:Organization
Organization Name:JANLINN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-695-6203
Mailing Address - Street 1:257 MONMOUTH RD
Mailing Address - Street 2:BUILDING B SUITE 5
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1500
Mailing Address - Country:US
Mailing Address - Phone:732-695-6203
Mailing Address - Fax:732-695-6204
Practice Address - Street 1:257 MONMOUTH RD
Practice Address - Street 2:BUILDING B SUITE 5
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1500
Practice Address - Country:US
Practice Address - Phone:732-695-6203
Practice Address - Fax:732-695-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04910600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126772Medicaid
NJ086860DHEMedicare PIN
NJ126772Medicaid