Shore Surgical Pavilion, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SHORE SURGICAL PAVILION, LLC

Practice address

475 Route 70
Suite 202
Lakewood, NJ 08701-5897

Phone

(732) 730-3939

Fax

(732) 730-9119

NPI assigned

Nov 17, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Douglas Manganelli, M.D.

Title

Medical Director

Phone

(732) 730-3939

Specialties & licenses 1

Addresses

Listed as

Shore Surgical Pavilion LLCCCN 31C0001290

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1154622579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 ROUTE 70",
            "address_2": "SUITE 202",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015897",
            "telephone_number": "732-730-3939",
            "fax_number": "732-730-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 ROUTE 70",
            "address_2": "SUITE 202",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015897",
            "telephone_number": "732-730-3939",
            "fax_number": "732-730-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE SURGICAL PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "MANGANELLI",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "732-730-3939",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shore Orthopaedic Group
• Shore Outpatient Surgicenter LLC
• Shore Point Medical Associates LLC
• Shore Point OB & GYN, LLC
• Shore Spine and Pain
• Shoshana Rose Physical Therapy
• Gitel Shreibman, MSED BCBA
• Tzivia Shreibman
• Shsnj LLC
• Miriam Shulman, LCSW

• Ambulatory Surgical Clinic/Center in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Ambulatory Surgical Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.