Organization
SHORELINE ORTHOPEDICS & SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN JEFFREY WHITE M.D. (PHYSICIAN PARTNER)
(860) 767-9053
Entity
Organization
Contact information
Practice address
12 BOKUM RD, ESSEX, CT 06426-1500
(860) 767-9053
(860) 767-1146
Mailing address
12 BOKUM RD, ESSEX, CT 06426-1500
(860) 767-9053
(860) 767-1146
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
027273
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004246824
—
CT
Enumeration date
07/08/2006
Last updated
12/08/2011
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