Provider Demographics
NPI:1811010549
Name:SHORE SPINE CENTER & PHYSICAL REHABILITATION, PC
Entity Type:Organization
Organization Name:SHORE SPINE CENTER & PHYSICAL REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBROU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-714-0070
Mailing Address - Street 1:1104 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2311
Mailing Address - Country:US
Mailing Address - Phone:732-714-0070
Mailing Address - Fax:732-714-0188
Practice Address - Street 1:1104 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2311
Practice Address - Country:US
Practice Address - Phone:732-714-0070
Practice Address - Fax:732-714-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05775111N00000X
171100000X, 207X00000X, 208100000X, 2081P2900X, 225100000X
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6396410001Medicare NSC