MEDICARE: FAMILY PRACTICE ASSOCIATES OF CAPE MAY COUNTY, PA

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	207Q00000X	Family Medicine Physician	25MB05175600	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DD5134	OTHER	NJ	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5295615	OTHER	NJ	AETNA PPO GROUP #
3	0590148	OTHER	NJ	AETNA HMO GROUP #
4	2404854001	OTHER	NJ	AMERIHEALTH GROUP #

General Provider Information

NPI Number	:	1790722163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE ASSOCIATES OF CAPE MAY COUNTY, PA

Provider Business Mailing Address
First Line	:	210 S SHORE RD
Second Line	:	MARMORA MEDICAL COMMONS, SUITE 100
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S SHORE RD
Second Line	:	MARMORA MEDICAL COMMONS, SUITE 100
City	:	MARMORA
State	:	NJ
Zip	:	08223-1200
Country	:	US
Telephone Number	:	609-390-0882
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. SANDEE K SHALLER
Credential	:	DO
Telephone Number	:	609-390-0882

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/15/2008

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Directions to “FAMILY PRACTICE ASSOCIATES OF CAPE MAY COUNTY, PA ” Practice Location

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