Provider Demographics
NPI:1609534783
Name:SHORE REGENERATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:SHORE REGENERATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-0222
Mailing Address - Street 1:137 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-2935
Mailing Address - Country:US
Mailing Address - Phone:732-244-0222
Mailing Address - Fax:732-244-0450
Practice Address - Street 1:137 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-2935
Practice Address - Country:US
Practice Address - Phone:732-244-0222
Practice Address - Fax:732-244-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty