Provider Demographics
NPI:1699874339
Name:SHORE CONTINENCE CENTER, P.C.
Entity type:Organization
Organization Name:SHORE CONTINENCE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CURN, NP
Authorized Official - Phone:732-244-9068
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-0513
Mailing Address - Country:US
Mailing Address - Phone:732-244-9068
Mailing Address - Fax:732-341-5644
Practice Address - Street 1:202 ROUTE 37 W
Practice Address - Street 2:SUITE 5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8055
Practice Address - Country:US
Practice Address - Phone:732-244-9068
Practice Address - Fax:732-341-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004557Medicare PIN