Basic Information
| Provider Information | |||||||||
| NPI: | 1811388853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHORE NEUROLOGY, PA | ||||||||
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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: | 02/12/2015 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | GOJDICS | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7322404787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | 25MA08860900 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.