1649327602 NPI number — SHORE CARDIOLOGY CONSULTANTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649327602 NPI number — SHORE CARDIOLOGY CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORE CARDIOLOGY CONSULTANTS LLC
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:
1649327602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 ROUTE 88
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08724-3036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-840-1900
Provider Business Mailing Address Fax Number:
732-840-0355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 ROUTE 88
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-840-1900
Provider Business Practice Location Address Fax Number:
732-840-0355
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOOSVI
Authorized Official First Name:
ALI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
732-840-1900

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7041705 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com