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General NPI Number Information
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NPI Number | 1134441686
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Entity Type | Organization
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Legal Business Name | SHORE PHARMACEUTICAL PROVIDERS
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 24812 82ND AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-2502
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Country | US
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Telephone | 718-347-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 24812 82ND AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-2502
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Country | US
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Telephone | 718-347-4844
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. IVAN GORDON
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Credential |
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Telephone | 516-938-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 33065
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License Number State | NY
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