MEDICARE: SHORE TOUCH PEDIATRICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	25MB0622960	NJ

General Provider Information

NPI Number	:	1326233578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE TOUCH PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	600 MULE ROAD
Second Line	:	SUITE 10
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-6460
Country	:	US
Telephone Number	:	732-557-5555
Fax Number	:	732-557-9555

Provider Business Practice Location Address
First Line	:	600 MULE ROAD
Second Line	:	SUITE 10
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-6460
Country	:	US
Telephone Number	:	732-557-5555
Fax Number	:	732-557-9555

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. NANCY S DEACON
Credential	:	D.O.,F.A.A.P.
Telephone Number	:	732-557-5555

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	10/22/2014

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