Provider Demographics
NPI:1407169519
Name:SHORE ENDOCRINOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SHORE ENDOCRINOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-892-7300
Mailing Address - Street 1:2200 RIVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2297
Mailing Address - Country:US
Mailing Address - Phone:732-892-7300
Mailing Address - Fax:732-892-7301
Practice Address - Street 1:2200 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2297
Practice Address - Country:US
Practice Address - Phone:732-892-7300
Practice Address - Fax:732-892-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty