Shore Surgical Assistant Service, LLC

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

26NO09467800 Issued in NJ

Legal business name

SHORE SURGICAL ASSISTANT SERVICE, LLC

Practice address

62 Tuckahoe Rd
Dorothy, NJ 08317-9702

Phone

(609) 476-4624

NPI assigned

Apr 9, 2007

Last updated

May 21, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary A Buck, CRNFANPI 1891889382

Title

Owner

Phone

(609) 476-4624

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary A Buck, CRNFA

  • Registered Nurse First Assistant
  • Dorothy, NJ
  • NPI 1891889382
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1104949528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331",
            "city": "MAYS LANDING",
            "state": "NJ",
            "postal_code": "083300331",
            "telephone_number": "973-957-0551",
            "fax_number": "866-396-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 TUCKAHOE RD",
            "city": "DOROTHY",
            "state": "NJ",
            "postal_code": "083179702",
            "telephone_number": "609-476-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE SURGICAL ASSISTANT SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-05-21",
        "certification_date": "2020-03-01",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-476-4624",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNFA"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "NJ",
            "license": "26NO09467800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elwyn New Jersey
• Kathleen Grizky, LCADC, CCS
• Bethany Suzanne Horvath
• Julie Elizabeth Powell, DC
• Ryan Samaroo II
• Weymouth Township Board of Education

• Registered Nurse First Assistant in Dorothy, NJ
• Providers in Dorothy, NJ by specialty
• Registered Nurse First Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.