Provider Demographics
NPI:1396277083
Name:SEASHORE PEDIATRIC THERAPY CENTER PC
Entity type:Organization
Organization Name:SEASHORE PEDIATRIC THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-713-9976
Mailing Address - Street 1:5 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-2835
Mailing Address - Country:US
Mailing Address - Phone:609-713-9976
Mailing Address - Fax:
Practice Address - Street 1:230 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3130
Practice Address - Country:US
Practice Address - Phone:609-713-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00573000261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty