Provider Demographics
NPI:1528396892
Name:SHORE OB GYN, P.C.
Entity Type:Organization
Organization Name:SHORE OB GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FOEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-4044
Mailing Address - Street 1:69 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8313
Mailing Address - Country:US
Mailing Address - Phone:631-665-4044
Mailing Address - Fax:631-665-3928
Practice Address - Street 1:69 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8313
Practice Address - Country:US
Practice Address - Phone:631-665-4044
Practice Address - Fax:631-665-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01569295Medicaid
NY01569295Medicaid
NY38H482Medicare PIN