Provider Demographics
NPI:1063466605
Name:SHORE HEART GROUP, PA
Entity Type:Organization
Organization Name:SHORE HEART GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-776-8500
Mailing Address - Street 1:1820 STATE ROUTE 33
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4860
Mailing Address - Country:US
Mailing Address - Phone:732-776-8500
Mailing Address - Fax:
Practice Address - Street 1:1820 STATE ROUTE 33
Practice Address - Street 2:SUITE 4B
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4860
Practice Address - Country:US
Practice Address - Phone:732-776-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0674383000OtherAMERIHEALTH
2100946OtherGHI
1095335OtherUNITED HEALTH CARE
J019935OtherTRICARE
457778OtherAETNA
NJ6063900Medicaid
CL6959OtherRAILROAD MEDICARE
457778OtherAETNA
=========OtherHORIZON BCBS