Provider Demographics
NPI:1134165210
Name:MID ATLANTIC GERIATRIC ASSOCIATES-OCEAN, P.A
Entity type:Organization
Organization Name:MID ATLANTIC GERIATRIC ASSOCIATES-OCEAN, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHUA-HAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP AGSF CMD
Authorized Official - Phone:732-657-6100
Mailing Address - Street 1:1043 ROUTE 70
Mailing Address - Street 2:UNIT C3
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5806
Mailing Address - Country:US
Mailing Address - Phone:732-657-6100
Mailing Address - Fax:732-657-0111
Practice Address - Street 1:1043 ROUTE 70
Practice Address - Street 2:UNIT C3
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-657-6100
Practice Address - Fax:732-657-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134165210OtherNPI
NJ092048Medicare ID - Type Unspecified