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NPI Code Detail

MEDICARE: SHORE MEDICAL TREATMENT PLLC

MEDICARE: SHORE MEDICAL TREATMENT PLLC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1457016669
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHORE MEDICAL TREATMENT PLLC
Provider Business Mailing Address
First Line : 350 JERICHO TPKE STE 1A
Second Line :
City : JERICHO
State : NY
Zip : 11753-1317
Country : US
Telephone Number : 973-333-4759
Fax Number :
Provider Business Practice Location Address
First Line : 350 JERICHO TPKE STE 1A
Second Line :
City : JERICHO
State : NY
Zip : 11753-1317
Country : US
Telephone Number : 973-333-4759
Fax Number :
Authorized Official
Title or Position : SOLE MEMBER OWNER
Name : CAROLINE NOVAK
Credential : MD
Telephone Number : 973-333-4759
Provider Enumeration Date : 11/02/2021
Last Update Date : 11/02/2021

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Directions to “SHORE MEDICAL TREATMENT PLLC ” Practice Location

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