Provider Demographics
NPI:1487986444
Name:SHOREMARK MEDICAL, LLC
Entity type:Organization
Organization Name:SHOREMARK MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PASSES
Authorized Official - Suffix:
Authorized Official - Credentials:DO/MBA
Authorized Official - Phone:732-292-3135
Mailing Address - Street 1:911 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2723
Mailing Address - Country:US
Mailing Address - Phone:732-292-3135
Mailing Address - Fax:732-280-2872
Practice Address - Street 1:911 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2723
Practice Address - Country:US
Practice Address - Phone:732-292-3135
Practice Address - Fax:732-280-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health