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General NPI Number Information
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NPI Number | 1417273616
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Entity Type | Organization
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Legal Business Name | ATLANTIC SHORE FAMILY PRACTICE, P.A.
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 1423 TILTON RD SUITE 3
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1865
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Country | US
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Telephone | 609-272-1441
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Fax | 609-272-8306
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Provider Business Mailing Address
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Address Line | 1423 TILTON RD SUITE 3
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1865
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Country | US
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Telephone | 609-272-1441
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Fax | 609-272-8306
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A. KADER
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Credential | D.O.
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Telephone | 609-272-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MB53762
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License Number State | NJ
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