MEDICARE: OCEAN HEALTH INITIATIVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	23027	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311842	OTHER	NJ	UGS

General Provider Information

NPI Number	:	1710980917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN HEALTH INITIATIVES

Provider Business Mailing Address
First Line	:	101 2ND ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3324
Country	:	US
Telephone Number	:	732-363-6655
Fax Number	:	732-363-6656

Provider Business Practice Location Address
First Line	:	101 2ND ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3324
Country	:	US
Telephone Number	:	732-363-6655
Fax Number	:	732-363-6656

Authorized Official
Title or Position	:	CEO
Name	:	THERESA BERGER
Credential	:
Telephone Number	:	732-363-6655

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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