Provider Demographics
NPI:1184752305
Name:SEASHORE SURGICAL INSTITUTE, LLC
Entity type:Organization
Organization Name:SEASHORE SURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PECORARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-836-9800
Mailing Address - Street 1:495 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7732
Mailing Address - Country:US
Mailing Address - Phone:732-836-9800
Mailing Address - Fax:732-836-3077
Practice Address - Street 1:495 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-836-9800
Practice Address - Fax:732-836-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23141261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001188OtherHORIZON BC BS OF NJ
NJJ29601OtherHEALTHNET
NJA2951537OtherOXFORD
NJP00083923OtherRAILROAD MEDICARE
NJ075233Medicare PIN