Provider Demographics
NPI:1063842383
Name:SHORE POINT OB & GYN, LLC
Entity Type:Organization
Organization Name:SHORE POINT OB & GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLAVIUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-905-6560
Mailing Address - Street 1:149 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4635
Mailing Address - Country:US
Mailing Address - Phone:732-905-6560
Mailing Address - Fax:732-818-9741
Practice Address - Street 1:149 BRISTOL CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4635
Practice Address - Country:US
Practice Address - Phone:732-905-6560
Practice Address - Fax:732-818-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04683000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD07129Medicare UPIN