Provider Demographics
NPI:1427131747
Name:SEASHORE MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:SEASHORE MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLOTOROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-641-1077
Mailing Address - Street 1:48 ANSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3058
Mailing Address - Country:US
Mailing Address - Phone:609-641-1077
Mailing Address - Fax:609-641-1023
Practice Address - Street 1:48 ANSLEY BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3058
Practice Address - Country:US
Practice Address - Phone:609-641-1077
Practice Address - Fax:609-641-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NJ207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2633604Medicaid
NJ113938Medicare ID - Type Unspecified