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General NPI Number Information
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NPI Number | 1366449571
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Entity Type | Organization
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Legal Business Name | SHORE OUTPATIENT SURGICENTER LLC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 360 ROUTE 70
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5823
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Country | US
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Telephone | 732-942-9835
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Fax | 732-886-1573
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Provider Business Mailing Address
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Address Line | 360 ROUTE 70
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5823
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Country | US
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Telephone | 732-942-9835
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Fax | 732-886-1573
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 22372
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License Number State | NJ
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