Healthcare Provider Details

I. General information

NPI: 1487986444
Provider Name (Legal Business Name): SHOREMARK MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MAIN ST
BELMAR NJ
07719-2723
US

IV. Provider business mailing address

911 MAIN ST
BELMAR NJ
07719-2723
US

V. Phone/Fax

Practice location:
  • Phone: 732-292-3135
  • Fax: 732-280-2872
Mailing address:
  • Phone: 732-292-3135
  • Fax: 732-280-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. PHILIP GEORGE PASSES
Title or Position: MANAGER
Credential: DO/MBA
Phone: 732-292-3135