Provider Demographics
NPI:1992057095
Name:ANNA SHOSHILOS, D.O, LLC
Entity type:Organization
Organization Name:ANNA SHOSHILOS, D.O, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOSHILOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-699-6765
Mailing Address - Street 1:96 LINWOOD PLZ
Mailing Address - Street 2:SUITE NUMBER: 347
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3701
Mailing Address - Country:US
Mailing Address - Phone:973-699-9765
Mailing Address - Fax:347-474-7300
Practice Address - Street 1:784 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE: G
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2272
Practice Address - Country:US
Practice Address - Phone:732-271-1771
Practice Address - Fax:732-271-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06906000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH02459Medicare UPIN