# SHORE SURGICAL ASSISTANT SERVICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104949528
- **Authorized official:** MR. GARY A BUCK CRNFA (OWNER)
- **Authorized official phone:** (609) 476-4624

## Contact information

- **Practice address:** 62 TUCKAHOE RD, DOROTHY, NJ 08317-9702
- **Practice address phone:** (609) 476-4624
- **Mailing address:** PO BOX 331, MAYS LANDING, NJ 08330-0331
- **Mailing address phone:** (973) 957-0551
- **Mailing address fax:** (866) 396-3054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WR0006X | Registered Nurse First Assistant | 26NO09467800 | NJ | Yes |

## Other

- **Enumeration date:** 04/09/2007
- **Last updated:** 05/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | $$$$$$$$$ | SSN | NJ |