Basic Information
Provider Information | |||||||||
NPI: | 1366464489 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHOMO | ||||||||
FirstName: | MARCIA | ||||||||
MiddleName: | R | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROSENBERG | ||||||||
OtherFirstName: | MARCIA | ||||||||
OtherMiddleName: | R | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2501 OREGON PIKE | ||||||||
Address2: | SUITE 101 | ||||||||
City: | LANCASTER | ||||||||
State: | PA | ||||||||
PostalCode: | 176014890 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172933223 | ||||||||
FaxNumber: | 7173902455 | ||||||||
Practice Location | |||||||||
Address1: | 99 HIGHWAY 37 W | ||||||||
Address2: |   | ||||||||
City: | TOMS RIVER | ||||||||
State: | NJ | ||||||||
PostalCode: | 087556423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6095976011 | ||||||||
FaxNumber: | 6099788944 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/25/2006 | ||||||||
LastUpdateDate: | 01/10/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MA05079600 | NJ | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.