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General NPI Number Information
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NPI Number | 1679656813
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Entity Type | Organization
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Legal Business Name | SHORE SURGICAL PROFESSIONAL ASSOCIATES
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 705 WHITE HORSE PIKE
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City | ABSECON
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State | NJ
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Zip | 08201-1468
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Country | US
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Telephone | 609-646-1739
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Fax | 609-646-7247
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Provider Business Mailing Address
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Address Line | 705 WHITE HORSE PIKE
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City | ABSECON
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State | NJ
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Zip | 08201-1468
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Country | US
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Telephone | 609-646-1739
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Fax | 609-646-7247
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Authorized Official
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Title or Position | GENERAL TRAUMA SURGERYOCCUPATIONAL
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Name | DR. GEORGE C GODFREY
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Credential | MD
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Telephone | 609-646-1739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA14407
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License Number State | NJ
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