# SHORE NURSE PRACTITIONER GROUP LLC

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

## Provider details

- **NPI number:** 1922335371
- **Authorized official:** MR. MUSTAK RAHMAN CPC,CPC-H (MANAGER)
- **Authorized official phone:** (848) 466-6011

## Contact information

- **Practice address:** 71 ANNAPOLIS ST, TINTON FALLS, NJ 07712-3175
- **Practice address phone:** (848) 466-6011
- **Practice address fax:** (732) 493-8475
- **Mailing address:** 71 ANNAPOLIS ST, TINTON FALLS, NJ 07712-3175
- **Mailing address phone:** (848) 466-6011
- **Mailing address fax:** (732) 493-8475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 26NJ00037000 | NJ | Yes |

## Other

- **Enumeration date:** 11/05/2009
- **Last updated:** 11/05/2009