Organization Name: | SHORE SURGICAL ASSISTING LLC |
NPI Number: | 1235497561 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONN M HOOSACK (OWNER) |
Mailing Address: | 1070 Clearwater Ave Manahawkin |
State: | NJ US |
Postal Code: | 080502303 |
Phone Number: | 7322361104 |
Fax Number: | 6099782750 |
NPI Enumeration Date: | 04/24/2012 |
NPI Last Update Date: | 09/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 25MP00132300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |