Provider Demographics
NPI:1407834674
Name:SHORE CARDIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:SHORE CARDIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-926-9010
Mailing Address - Street 1:408 BETHEL RD
Mailing Address - Street 2:POINT COMMONS BLDG D
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2172
Mailing Address - Country:US
Mailing Address - Phone:609-926-9010
Mailing Address - Fax:609-926-3392
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:POINT COMMONS BLDG D
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-9010
Practice Address - Fax:609-926-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04287700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0419907Medicaid
550424CB0Medicare ID - Type Unspecified
D06878Medicare UPIN