SHORE OUTPATIENT SURGICENTER LLC NPI 1366449571

NPI Information

NPI: 1366449571
Provider Name: SHORE OUTPATIENT SURGICENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 31D0937892

Address:
360 ROUTE 70
LAKEWOOD, NJ
ZIP 08701
Phone: (732) 942-9835
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SHORE OUTPATIENT SURGICENTER LLC is an ambulatory surgical clinic center in Lakewood, NJ. SHORE OUTPATIENT SURGICENTER LLC NPI is 1366449571. The provider is registered as an organization entity type.

The provider's business location address is:

360 ROUTE 70
LAKEWOOD, NJ
ZIP 08701-823
Phone: (732) 942-9835
Fax: (732) 886-1573

The provider's authorized official is Jonathan Bailey .
The authorized official title is Authorized Official and has the following contact phone number (203) 609-1168.

The CLIA number assigned to this NPI record is 31D0937892 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/1/2005 and was last updated on 12/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	22372	NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7642504	MEDICAID	NEW JERSEY
2	490003641	OTHER	NEW JERSEY	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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