1699874339 NPI number — SHORE CONTINENCE CENTER, P.C.

Table of content: (NPI 1699874339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699874339 NPI number — SHORE CONTINENCE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORE CONTINENCE CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699874339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 513
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-0513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-244-9068
Provider Business Mailing Address Fax Number:
732-341-5644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 ROUTE 37 W
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-8055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-244-9068
Provider Business Practice Location Address Fax Number:
732-341-5644
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REILLY
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-244-9068

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)