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JACKSON FAMILY PRACTICE LLC
NPI 1922244060
Family Medicine in Freehold, NJ

Active since December 19, 2008CLIA 31D1094599 · Waiver
80 SCENIC DR, SUITE 6, FREEHOLD, NJ 07728(732) 683-0010 Get Directions Write a Review

NPPES record last updated: June 21, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Family Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON FAMILY PRACTICE LLC (NPI 1922244060) is a healthcare organization registered as a family medicine in Freehold, New Jersey and active in the NPI registry since December 2008. The organization holds a CLIA Waiver certificate valid through January 21, 2027 and lists Miah Kim, Owner, as its authorized official.

NPPES Registry Identity

NPI1922244060
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameJACKSON FAMILY PRACTICE LLC
Location Address80 SCENIC DR, SUITE 6Freehold, NJ 07728-5210
Mailing Address80 Scenic Dr, Suite 6Freehold, NJ 07728-5210 · (732) 683-0010
Phone(732) 683-0010
Organization SubpartNo
Authorized OfficialMiah KimOwner · (732) 683-0010
Enumeration DateDecember 19, 2008
Last NPPES UpdateJune 21, 2018
✔ NPI 1922244060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in NJ · 25MB05981900
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
80 SCENIC DR, Freehold, NJ 07728
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D1094599

Jackson Family Practice, LLC · Freehold, NJ
Active · expires Jan 21, 2027
CLIA Number31D1094599
Laboratory TypePhysician Office
Certificate Effective DateJanuary 22, 2025
Certificate Expiration DateJanuary 21, 2027
Laboratory DirectorMiah Kim
Laboratory Phone(732) 683-0010
Laboratory LocationJackson Family Practice, LLC55 Schanck Road, Suite A 20, Freehold, NJ 07728
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HELEN KRAUS LSW
Social Worker
80 SCENIC DR
FREEHOLD, NJ 07728
Monmouth County (732) 538-8424
ELAINE MARIAN WEIGL L.P.C.
Counselor
80 SCENIC DR, SUITE 2
FREEHOLD, NJ 07728
Monmouth County (732) 682-1449
ESTHER GANZ, LLC
Counselor (Professional)
80 SCENIC DR, SUITE 2
FREEHOLD, NJ 07728
Monmouth County (732) 995-1246
RENAY FRIEDMAN, D.C., L.L.C.
Physical Therapist
80 SCENIC DR, SUITE 4
FREEHOLD, NJ 07728
Monmouth County (732) 863-7400
MARK GERSHENBAUM, DO, LLC
Family Medicine
80 SCENIC DR, SUITE 3
FREEHOLD, NJ 07728
Monmouth County (732) 255-2252
MS. DEBORAH A TOBIAS MSW LCSW
Social Worker (Clinical)
80 SCENIC DR, SUITE 2
FREEHOLD, NJ 07728
Monmouth County (732) 462-2622
REGINA ROSSI, DO LLC
Family Medicine
80 SCENIC DR
FREEHOLD, NJ 07728
Monmouth County (732) 409-6969
ULTRASOUND ASSOCIATES INCORPORATED
Radiologic Technologist (Sonography)
80 SCENIC DR, SUITE 6
FREEHOLD, NJ 07728
Monmouth County (732) 899-9940

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Family Practice LLC's NPI number?

The NPI number for Jackson Family Practice LLC is 1922244060. It was assigned to this organization in the NPPES registry on December 19, 2008.

Where is Jackson Family Practice LLC located?

Jackson Family Practice LLC is located at 80 Scenic Dr Suite 6, Freehold, NJ 07728. The listed phone number is (732) 683-0010.

What is Jackson Family Practice LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Jackson Family Practice LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D1094599) is associated with this NPI, valid through January 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jackson Family Practice LLC was last updated on June 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.