NPIMap

Organization Active NPI

Atlantic Shore Surgical Associates, PC

  • Surgery Physician
  • Brick, NJ
National Provider Identifier
1851470124
Registry record updated Aug 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ATLANTIC SHORE SURGICAL ASSOCIATES, PC
Practice address
478 Brick Blvd
Brick, NJ 08723-6077
Phone
(732) 701-4848
Fax
(732) 701-1244
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2014

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

Authorized official

Name
Mrs. Debra J Hagaman
Title
Manager
Phone
(732) 701-4848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X NJ Primary

Addresses

Primary practice location

478 Brick Blvd
Brick, NJ 08723-6077

Mailing address

478 Brick Blvd
Brick, NJ 08723-6077
Phone (732) 701-4848

Other identifiers 1

IdentifierTypeStateIssuer
8727503MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000163 NJ Part B Supplier - Clinic/Group Practice 0446222533 Receives reassigned benefits from 22 practitioners
Practice locations: Brick, NJ

National Provider Directory

National Provider Directory

Locations

478 Brick Blvd
Brick, NJ 08723
Phone (732) 701-4848

208 Jack Martin Blvd
Ste C1
Brick, NJ 08724
Phone (732) 701-4848

3822 River Rd
Point Pleasant Boro, NJ 08742
Phone (732) 701-4848

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1851470124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 BRICK BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236077",
            "telephone_number": "732-701-4848",
            "fax_number": "732-701-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 BRICK BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236077",
            "telephone_number": "732-701-4848",
            "fax_number": "732-701-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC SHORE SURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "HAGAMAN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "732-701-4848",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8727503",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.