Healthcare Provider Details

I. General information

NPI: 1902829286
Provider Name (Legal Business Name): SOUTH SHORE ANESTHESIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6314 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-5543
US

IV. Provider business mailing address

PO BOX 237
NORTHFIELD NJ
08225-0237
US

V. Phone/Fax

Practice location:
  • Phone: 609-813-2190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND BERNARD
Title or Position: OWNER-PRESIDENT
Credential:
Phone: 609-813-2190