Provider Demographics
NPI:1972185593
Name:SHORE EEG CONSULTING LLC
Entity Type:Organization
Organization Name:SHORE EEG CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-947-6132
Mailing Address - Street 1:27 WILDFLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-2516
Mailing Address - Country:US
Mailing Address - Phone:609-947-6132
Mailing Address - Fax:
Practice Address - Street 1:27 WILDFLOWER TRL
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-2516
Practice Address - Country:US
Practice Address - Phone:609-947-6132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No273100000XHospital UnitsEpilepsy Unit