Provider Demographics
NPI:1306242706
Name:SHORE REHAB & WELLNESS, LLC
Entity type:Organization
Organization Name:SHORE REHAB & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-406-5030
Mailing Address - Street 1:883 POOLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:883 POOLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2040
Practice Address - Country:US
Practice Address - Phone:732-431-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty