Healthcare Provider Details

I. General information

NPI: 1962562751
Provider Name (Legal Business Name): SHORE INSTITUTE FOR REPRODUCTIVE MEDICINE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HIGHWAY 70 SUITE 201
LAKEWOOD NJ
08701-5897
US

IV. Provider business mailing address

475 HIGHWAY 70 SUITE 201
LAKEWOOD NJ
08701-5897
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-0907
  • Fax: 732-363-2004
Mailing address:
  • Phone: 732-363-0907
  • Fax: 732-363-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNJ

VIII. Authorized Official

Name: ALLEN MORGAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 732-363-0907