Shore Memorial Hospital
Organization Active NPI Hematology & Oncology Physician · Somers Point, NJ
NPI 1689795338 · NPPES record last updated May 30, 2014
Key facts
- NPI
- 1689795338
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- MB052916 (NJ)
- Legal business name
- SHORE MEMORIAL HOSPITAL
- Practice address
- 1 East New York Ave
Somers Point, NJ 08244-2340 - Phone
- (609) 653-3213
- Fax
- (609) 653-3942
- NPI assigned
- Apr 2, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SHORE MEMORIAL HOSPITAL
Authorized official
- Name
- Mr. Ronald W. Johnson
- Title
- President and Ceo
- Phone
- (609) 653-3545
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 4
Member organizations 2
Practitioners 50
-
Christine Marie Ablett, APN-C
-
Jannine Denise Bournias, AGNP
-
Brenda Patricia Bruck, PMHNP
-
Linda Mary Degrazia, APN
-
Kimberly Ann Thomas, NURSE PRACTITIONER
-
John J Wilson, MD
-
Susan Zink, M.D.
-
Jenys Allende, M.D.
-
Matthew Kelly Janssen, M.D.
-
Omar Al Ustwani, MD
-
Benjamin P Negin, M.D.
-
Shailja Roy, MD
-
Kush Sachdeva, MD
-
Vijay Krishna Sandilya, M.D.
-
Mylene Sy Go, M.D
-
Vijay Babu Balakrishnan, M.D., CCD.
-
Arianna Barres, DO
-
Robert Bishop, APN
-
Robert H Debbs, DO
-
Michael Anthony Giunta, M.D.
-
Rajesh V Iyer, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Shore Medical Center |
Hospital | Operational/Managerial Control | Aug 16, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080128000527 | NJ | Part B Supplier - Clinic/Group Practice | 1052493202 |
Receives reassigned benefits from 38 practitioners Practice locations: Somers Point, NJ |
National Provider Directory
- Tax ID family
- Shore Memorial Hospital
- Part of
- Shore Memorial Hospital
Locations
501 Zion Rd
Egg Harbor Twp, NJ 08234
Phone (609) 927-8069
914 Haven Ave
Ocean City, NJ 08226
Phone (609) 391-8105
415 Shore Rd
Somers Point, NJ 08244
Phone (609) 653-3711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | MA65533 | NJ | |
| Social Worker |
104100000X | NJ | ||
| Nutritionist |
133N00000X | MA65533 | NJ | |
| Critical Care Medicine (Internal Medicine) Physician |
207RC0200X | 25MA04612900 | NJ | |
| Hematology & Oncology Physician |
207RH0003X | MB052916 | NJ | Yes |
| Pulmonary Disease Physician |
207RP1001X | 25MA04612900 | NJ | |
| Obstetrics & Gynecology Physician |
207V00000X | MA65533 | NJ | |
| Neonatal-Perinatal Medicine Physician |
2080N0001X | MA65533 | NJ | |
| Neonatal-Perinatal Medicine Physician |
2080N0001X | NJ | ||
| Radiation Oncology Physician |
2085R0001X | 25MA08489700 | NJ |
Addresses
Primary practice location
1 East New York Ave
Somers Point, NJ 08244-2340
Mailing address
1 East New York Ave
Somers Point, NJ 08244-2340
Phone (609) 653-3213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8948909 | Medicaid | NJ |
Other names
- SMH Professional Services
Other providers in Somers Point, NJ
- Shore Heart Consultants LLC
- Shore Hospitalists Associates PA
- Shore Laboratory Diagnostics, LLC
- Shore Medical
- Shore Memorial Hospital
- Shore Memorial Hospital
- Shore Memorial Physicians Group PC
- Shore Orthopaedic University Associates PA
- Shore Orthopedic University Associates PA
- Shore Pathology Associates P.C.
All providers in Somers Point, NJ · Hematology & Oncology Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.