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General NPI Number Information
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NPI Number | 1003926171
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Entity Type | Organization
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Legal Business Name | SHORE NEPHROLOGY PA.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 2100 CORLIES AVE SUITE 15
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City | NEPTUNE
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State | NJ
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Zip | 07753-6102
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Country | US
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Telephone | 732-988-8228
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Fax | 732-451-0059
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Provider Business Mailing Address
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Address Line | 2100 CORLIES AVE SUITE 15
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City | NEPTUNE
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State | NJ
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Zip | 07753-6102
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Country | US
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Telephone | 732-988-8228
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Fax | 732-451-0059
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Authorized Official
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Title or Position | BILLING CODING MANAGER
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Name | MUSTAK RAHMAN
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Credential | CPC CPC-H
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Telephone | 732-455-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State | NJ
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