Provider Demographics
NPI:1902777600
Name:EAST SHORELINE SUPPLIES INC
Entity type:Organization
Organization Name:EAST SHORELINE SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UNKNOWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD SHAHID ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-568-8302
Mailing Address - Street 1:1699 WALL ST STE 550C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1699 WALL ST STE 550C
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5786
Practice Address - Country:US
Practice Address - Phone:213-568-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory