Provider Demographics
NPI:1053382499
Name:SHORE PULMONARY, PA
Entity type:Organization
Organization Name:SHORE PULMONARY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-9075
Mailing Address - Street 1:2640 HIGHWAY 70
Mailing Address - Street 2:BUILDING 6-A
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2609
Mailing Address - Country:US
Mailing Address - Phone:732-528-5900
Mailing Address - Fax:732-775-1212
Practice Address - Street 1:2640 HIGHWAY 70
Practice Address - Street 2:BUILDING 6-A
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-528-5900
Practice Address - Fax:732-775-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3020401Medicaid
NJ432564Medicare ID - Type Unspecified