Provider Demographics
NPI:1225211592
Name:SHOULSON & ASSOCIATES FAMILY PRACTICE
Entity Type:Organization
Organization Name:SHOULSON & ASSOCIATES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOULSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-246-7879
Mailing Address - Street 1:1553 STATE ROUTE 27
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3980
Mailing Address - Country:US
Mailing Address - Phone:732-246-7879
Mailing Address - Fax:732-246-7876
Practice Address - Street 1:1553 STATE ROUTE 27
Practice Address - Street 2:SUITE 3300
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3980
Practice Address - Country:US
Practice Address - Phone:732-246-7879
Practice Address - Fax:732-246-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095672Medicare PIN