Provider Demographics
NPI:1124879598
Name:SHORE HEALTH WELLNESS CENTER
Entity type:Organization
Organization Name:SHORE HEALTH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-693-2097
Mailing Address - Street 1:137 ATLANTIC CITY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-2935
Mailing Address - Country:US
Mailing Address - Phone:732-693-2097
Mailing Address - Fax:732-244-0046
Practice Address - Street 1:137 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-2935
Practice Address - Country:US
Practice Address - Phone:732-693-2097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty