Provider Demographics
NPI:1316157464
Name:SOUTHSHORE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHSHORE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANEGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-1203
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-888-1203
Mailing Address - Fax:732-888-1204
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:SUITE 35
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-888-1203
Practice Address - Fax:732-888-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ309505OtherAETNA HMO
NJ072312Medicare PIN
NJH30607Medicare UPIN