Healthcare Provider Details

I. General information

NPI: 1427131747
Provider Name (Legal Business Name): SEASHORE MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ANSLEY BLVD
PLEASANTVILLE NJ
08232-3058
US

IV. Provider business mailing address

48 ANSLEY BLVD
PLEASANTVILLE NJ
08232-3058
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-1077
  • Fax: 609-641-1023
Mailing address:
  • Phone: 609-641-1077
  • Fax: 609-641-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. JON W SLOTOROFF
Title or Position: PRESIDENT
Credential: DO
Phone: 609-641-1077