Provider Demographics
NPI:1336422310
Name:SHORE HYPERBARIC LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SHORE HYPERBARIC LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DIFLUMERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-674-3497
Mailing Address - Street 1:4 COVE POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4722
Mailing Address - Country:US
Mailing Address - Phone:732-674-3497
Mailing Address - Fax:877-606-3662
Practice Address - Street 1:99 HWY 37 WEST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:732-557-2121
Practice Address - Fax:732-557-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02111100207R00000X
NJMA021111261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63261Medicaid
NJC63261Medicaid