Basic Information
| Provider Information | |||||||||
| NPI: | 1780642827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHORE NEUROLOGY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 RTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322404787 | ||||||||
| FaxNumber: | 7322403114 | ||||||||
| Practice Location | |||||||||
| Address1: | 633 RTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322404787 | ||||||||
| FaxNumber: | 7322403114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | MISKIN | ||||||||
| AuthorizedOfficialFirstName: | PANDURANG | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7322404787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA04195700 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | D02228 | 01 | NJ | RAILROAD | OTHER | 3144402 | 05 | NJ | MEDICAID | 0038295 | 01 | NJ | AETNA | OTHER |