Provider Demographics
NPI:1851470124
Name:ATLANTIC SHORE SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ATLANTIC SHORE SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-701-4848
Mailing Address - Street 1:478 BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6077
Mailing Address - Country:US
Mailing Address - Phone:732-701-4848
Mailing Address - Fax:732-701-1244
Practice Address - Street 1:478 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6077
Practice Address - Country:US
Practice Address - Phone:732-701-4848
Practice Address - Fax:732-701-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8727503Medicaid
NJ8727503Medicaid
NJCK2471Medicare PIN