=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336145283
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE ORTHOPEDIC & ATHLETIC REHABILITATION, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2123 HIGHWAY 35
-----------------------------------------------------
City | SEA GIRT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08750-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-449-2001
-----------------------------------------------------
Fax | 732-449-2238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2123 HIGHWAY 35
-----------------------------------------------------
City | SEA GIRT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08750-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-449-2001
-----------------------------------------------------
Fax | 732-449-2238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEFFREY SNYDER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 732-449-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------