Provider Demographics
NPI:1689623670
Name:SHORE, ROBIN LESLIE (DO)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LESLIE
Last Name:SHORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:VALLEY EMERGENCY ROOM ASSOCIATES PA
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:223 N VAN DIEN AVENUE
Practice Address - Street 2:THE VALLEY HOSPITAL
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-2019
Practice Address - Fax:201-444-3604
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06022000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6931405Medicaid
NJ874201Medicare ID - Type Unspecified
G28259Medicare UPIN