Basic Information
| Provider Information | |||||||||
| NPI: | 1205034816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN SURGICAL & ONCOLOGY ASSOCIATES, P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 478 BRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087236077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327014848 | ||||||||
| FaxNumber: | 7327011469 | ||||||||
| Practice Location | |||||||||
| Address1: | 478 BRICK BLVD | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087236077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327014848 | ||||||||
| FaxNumber: | 7327011469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | HAGAMAN | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7327014848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 25MA08247200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | ZE1773 | 01 | NJ | HEALTHNET | OTHER | 0159794 | 05 | NJ | MEDICAID | DH1203 | 01 | NJ | RR MEDICARE | OTHER |