Provider Demographics
NPI:1659384550
Name:SHORELINE ENDOCRINE & MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:SHORELINE ENDOCRINE & MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-813-2200
Mailing Address - Street 1:707 WHITE HORSE PIKE STE C1
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1461
Mailing Address - Country:US
Mailing Address - Phone:609-813-2200
Mailing Address - Fax:609-813-2201
Practice Address - Street 1:707 WHITE HORSE PIKE STE C1
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1461
Practice Address - Country:US
Practice Address - Phone:609-813-2200
Practice Address - Fax:609-813-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07015200207R00000X
NJ25MB07015100207R00000X
NJ25MA05837600207RE0101X
NJ26NJ00004700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037985Medicare ID - Type Unspecified