Provider Demographics
NPI:1356522106
Name:SHORE HEMATOLOGY-ONCOLOGY PRACTICE,LLC
Entity type:Organization
Organization Name:SHORE HEMATOLOGY-ONCOLOGY PRACTICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-0068
Mailing Address - Street 1:40 BEY LEA RD
Mailing Address - Street 2:SUITE C202
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2900
Mailing Address - Country:US
Mailing Address - Phone:732-240-0068
Mailing Address - Fax:732-240-1574
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:SUITE C202
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-240-0068
Practice Address - Fax:732-240-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH60389Medicare UPIN