Provider Demographics
NPI:1013303874
Name:SHORE MEDICAL CENTER
Entity Type:Organization
Organization Name:SHORE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISHER-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:609-892-9102
Mailing Address - Street 1:316 ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6986
Mailing Address - Country:US
Mailing Address - Phone:609-892-9102
Mailing Address - Fax:
Practice Address - Street 1:316 ISLAND LN
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6986
Practice Address - Country:US
Practice Address - Phone:609-892-9102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00557300282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital