Provider Demographics
NPI:1508882051
Name:SHORE ATLANTIC GERIATRICS LLC
Entity Type:Organization
Organization Name:SHORE ATLANTIC GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALOYSIUS
Authorized Official - Middle Name:CHUKWUMUCHE
Authorized Official - Last Name:ONWUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-886-4441
Mailing Address - Street 1:1740 BAYSHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251
Mailing Address - Country:US
Mailing Address - Phone:609-886-4441
Mailing Address - Fax:609-889-1766
Practice Address - Street 1:1740 BAYSHORE ROAD
Practice Address - Street 2:
Practice Address - City:VILLAS
Practice Address - State:NJ
Practice Address - Zip Code:08251
Practice Address - Country:US
Practice Address - Phone:609-886-4441
Practice Address - Fax:609-889-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039861Medicaid
NJ093993Medicare ID - Type Unspecified