Provider Demographics
NPI:1558432567
Name:SHORE FIRST ASSISTANT SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:SHORE FIRST ASSISTANT SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, RN FIRST ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C, CRNFA
Authorized Official - Phone:609-226-1721
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-0534
Mailing Address - Country:US
Mailing Address - Phone:973-957-0548
Mailing Address - Fax:866-395-0888
Practice Address - Street 1:7 EAST DR
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2214
Practice Address - Country:US
Practice Address - Phone:973-957-0548
Practice Address - Fax:866-395-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08868500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty