Provider Demographics
NPI:1942731450
Name:SHORE MEDICINE & PEDIATRICS ASSOCIATES P A
Entity Type:Organization
Organization Name:SHORE MEDICINE & PEDIATRICS ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRAN
Authorized Official - Middle Name:THIRUNAVU
Authorized Official - Last Name:RAJARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-544-8899
Mailing Address - Street 1:59 AVENUE AT THE CMN STE 105
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4559
Mailing Address - Country:US
Mailing Address - Phone:732-544-8899
Mailing Address - Fax:732-544-9888
Practice Address - Street 1:59 AVENUE AT THE CMN STE 105
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4559
Practice Address - Country:US
Practice Address - Phone:732-544-8899
Practice Address - Fax:732-544-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO7526600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI30332Medicaid