Provider Demographics
NPI:1689743130
Name:SHORE ORTHOPAEDIC GROUP LLC
Entity Type:Organization
Organization Name:SHORE ORTHOPAEDIC GROUP LLC
Other - Org Name:SHORE ORTHOPAEDIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-530-1515
Mailing Address - Street 1:35 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4917
Mailing Address - Country:US
Mailing Address - Phone:732-530-1515
Mailing Address - Fax:732-345-6497
Practice Address - Street 1:35 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4917
Practice Address - Country:US
Practice Address - Phone:732-530-1515
Practice Address - Fax:732-345-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148664Medicare PIN