=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013531193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL SHOR DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2020
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 ROUTE 73 N STE 117
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-316-7666
-----------------------------------------------------
Fax | 609-451-0873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 ECHELON RD
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MB11677100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------