Provider Demographics
NPI:1104210418
Name:SHORE CARDIAC CENTER LLC
Entity Type:Organization
Organization Name:SHORE CARDIAC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:732-330-2566
Mailing Address - Street 1:651 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8060
Mailing Address - Country:US
Mailing Address - Phone:732-286-6103
Mailing Address - Fax:732-518-5252
Practice Address - Street 1:651 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8060
Practice Address - Country:US
Practice Address - Phone:732-286-6103
Practice Address - Fax:732-518-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09530100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061697Medicaid
NJ0061697Medicaid