Provider Demographics
NPI:1962464404
Name:SHORE MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:SHORE MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:H
Authorized Official - Last Name:CONDIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-349-0011
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-0289
Mailing Address - Country:US
Mailing Address - Phone:732-240-4545
Mailing Address - Fax:732-505-3257
Practice Address - Street 1:601 RT 37 W
Practice Address - Street 2:STE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-240-4545
Practice Address - Fax:732-505-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC19107OtherRR MCR
007248Medicare ID - Type Unspecified