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General NPI Number Information
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NPI Number | 1255531224
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Entity Type | Organization
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Legal Business Name | ATLANTIC SHORE MEDICAL, PA
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2100 CORLIES AVE SUITE # 20
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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 | 732-776-9776
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Fax | 732-776-9882
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Provider Business Mailing Address
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Address Line | PO BOX 2212
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City | NEPTUNE
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State | NJ
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Zip | 07754-2212
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Country | US
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Telephone | 732-776-9776
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Fax | 732-776-9882
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LOOKMAN K ODEJOBI
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Credential | M.D.
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Telephone | 732-776-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA 062733
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License Number State | NJ
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