Healthcare Provider Details

I. General information

NPI: 1063466605
Provider Name (Legal Business Name): SHORE HEART GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-8500
  • Fax:
Mailing address:
  • Phone: 732-776-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURICE D WEISS
Title or Position: PRESIDENT
Credential: MD
Phone: 732-776-8500