# SHORELINE ORTHOPEDICS & SPORTS MEDICINE, LLC

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

## Provider details

- **NPI number:** 1861425597
- **Authorized official:** MARTIN JEFFREY WHITE M.D. (PHYSICIAN PARTNER)
- **Authorized official phone:** (860) 767-9053

## Contact information

- **Practice address:** 12 BOKUM RD, ESSEX, CT 06426-1500
- **Practice address phone:** (860) 767-9053
- **Practice address fax:** (860) 767-1146
- **Mailing address:** 12 BOKUM RD, ESSEX, CT 06426-1500
- **Mailing address phone:** (860) 767-9053
- **Mailing address fax:** (860) 767-1146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 027273 | CT | — |

## Other

- **Enumeration date:** 07/08/2006
- **Last updated:** 12/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004246824 | — | CT |