Provider Demographics
NPI:1962559930
Name:ATLANTIC OFF SHORE MEDICAL ASSOCIATES P.A.
Entity type:Organization
Organization Name:ATLANTIC OFF SHORE MEDICAL ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-909-0200
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:BUILDING 200, SUITE 214
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-909-0200
Mailing Address - Fax:609-909-0267
Practice Address - Street 1:5401 HARDING HWY
Practice Address - Street 2:SUITE # 5
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2243
Practice Address - Country:US
Practice Address - Phone:609-909-0200
Practice Address - Fax:609-909-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04430100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091082Medicare ID - Type UnspecifiedMEDICARE GROUP #