Organization
SHORE OUTPATIENT SURGICENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BAILEY (AUTHORIZED OFFICIAL)
(203) 609-1168
Entity
Organization
Contact information
Practice address
360 ROUTE 70, LAKEWOOD, NJ 08701-5823
(732) 942-9835
(732) 886-1573
Mailing address
360 ROUTE 70, LAKEWOOD, NJ 08701-5823
(732) 942-9835
(732) 886-1573
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
22372
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490003641
RAILROAD MEDICARE
NJ
05
—
7642504
—
NJ
Enumeration date
07/01/2005
Last updated
01/16/2025
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