Healthcare Provider Details

I. General information

NPI: 1245694520
Provider Name (Legal Business Name): SHORE ORTHOPEDICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 IDLEWILD AVE
EASTON MD
21601-3881
US

IV. Provider business mailing address

510 IDLEWILD AVE
EASTON MD
21601-3881
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8226
  • Fax: 410-820-8405
Mailing address:
  • Phone: 410-820-8226
  • Fax: 410-820-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON J JANCOSKO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 410-820-8226