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NPI Code Detail

MEDICARE: SHORE RADIATION ONCOLOGY, LLC.

MEDICARE: SHORE RADIATION ONCOLOGY, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician25MA07348800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780686741
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHORE RADIATION ONCOLOGY, LLC.
Provider Business Mailing Address
First Line : 425 JACK MARTIN BLVD
Second Line :
City : BRICK
State : NJ
Zip : 08724-7732
Country : US
Telephone Number : 732-836-4130
Fax Number : 732-836-4036
Provider Business Practice Location Address
First Line : 425 JACK MARTIN BLVD
Second Line :
City : BRICK
State : NJ
Zip : 08724-7732
Country : US
Telephone Number : 732-836-4130
Fax Number : 732-836-4036
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. CONNIE MARNIN
Credential :
Telephone Number : 732-836-4130
Provider Enumeration Date : 06/02/2005
Last Update Date : 08/22/2020

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