Provider Demographics
NPI:1174606396
Name:SOUTH SHORE ANESTHESIA AND PAIN
Entity type:Organization
Organization Name:SOUTH SHORE ANESTHESIA AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:866-291-9707
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-0237
Mailing Address - Country:US
Mailing Address - Phone:866-291-9707
Mailing Address - Fax:
Practice Address - Street 1:301 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8340
Practice Address - Country:US
Practice Address - Phone:609-653-9000
Practice Address - Fax:609-653-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty