Provider Demographics
NPI:1427276450
Name:SHORE GERIATRICS, LLC
Entity type:Organization
Organization Name:SHORE GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REGALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-245-1563
Mailing Address - Street 1:401 W SYLVANIA AVE
Mailing Address - Street 2:APT 6-B
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5979
Mailing Address - Country:US
Mailing Address - Phone:732-245-1563
Mailing Address - Fax:732-974-1985
Practice Address - Street 1:700 ROUTE 71
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750
Practice Address - Country:US
Practice Address - Phone:732-974-3146
Practice Address - Fax:732-974-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08154900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty