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Gary J Shore

Internal Medicine

Allopathic & Osteopathic Physicians

31 Merrick Ave, Suite 230, Merrick, NY 11566-3477

PECOS Enrollment

This provider is enrolled in PECOS as GARY SHORE.

Based on the most recent information from CMS, provider Gary J Shore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1659354942
Provider Type
Individual
Full Name
Shore, Gary J
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
11/21/2005
Last Updated
4/20/2010

Contact Information

Practice Location

31 Merrick Ave, Suite 230, Merrick, NY 11566-3477

(516) 377-2820

(516) 378-2968

Mailing Location

87 E Lexington Ave, Oceanside, NY 11572-5420

(516) 377-2820

(516) 378-2968

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 179490 New York

Provider Identifiers

ID	Description	Issuer
ID 01432833	Description Medicaid	Issuer Unlisted New York

Gary J Shore

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Edayadi, Alexander P

Bellan, Pamela Ann

Gary Shore Md Pc