Basic Information
| Provider Information | |||||||||
| NPI: | 1730365693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN SONO MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 234911 | ||||||||
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| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110234911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312771803 | ||||||||
| FaxNumber: | 6315810015 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312771803 | ||||||||
| FaxNumber: | 6315810015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | BILELLA | ||||||||
| AuthorizedOfficialFirstName: | DOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MGR | ||||||||
| AuthorizedOfficialTelephone: | 6312771803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.