Healthcare Provider Details

I. General information

NPI: 1689795338
Provider Name (Legal Business Name): SHORE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAST NEW YORK AVE
SOMERS POINT NJ
08244-2340
US

IV. Provider business mailing address

1 EAST NEW YORK AVE
SOMERS POINT NJ
08244-2340
US

V. Phone/Fax

Practice location:
  • Phone: 609-653-3213
  • Fax: 609-653-3942
Mailing address:
  • Phone: 609-653-3213
  • Fax: 609-653-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA04612900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA04612900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA08489700
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMA65533
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberMA65533
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA65533
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMA65533
License Number StateNJ
# 10
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMB052916
License Number StateNJ

VIII. Authorized Official

Name: MR. RONALD W. JOHNSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 609-653-3545