Healthcare Provider Details

I. General information

NPI: 1629070149
Provider Name (Legal Business Name): SHORE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 609-653-3545
  • Fax:
Mailing address:
  • Phone: 609-653-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10103
License Number StateNJ

VIII. Authorized Official

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