Provider Demographics
NPI:1659821742
Name:SHORE ORTHOPAEDIC GROUP
Entity Type:Organization
Organization Name:SHORE ORTHOPAEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-942-2020
Mailing Address - Street 1:1255 ROUTE 70
Mailing Address - Street 2:SUITE 10-N
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5900
Mailing Address - Country:US
Mailing Address - Phone:732-942-2020
Mailing Address - Fax:
Practice Address - Street 1:1255 ROUTE 70
Practice Address - Street 2:SUITE 10-N
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5900
Practice Address - Country:US
Practice Address - Phone:732-942-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07424100332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site