MEDICARE: OCEAN AVE MEDICAL SERVICES, PLLC

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	207V00000X	Obstetrics & Gynecology Physician	197888	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	462120	OTHER	NY	JCHAO

General Provider Information

NPI Number	:	1982926168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN AVE MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2736 OCEAN AVE
Second Line	:	SUITE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4705
Country	:	US
Telephone Number	:	718-837-4466
Fax Number	:	718-837-1179

Provider Business Practice Location Address
First Line	:	2736 OCEAN AVE
Second Line	:	SUITE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4705
Country	:	US
Telephone Number	:	718-837-4466
Fax Number	:	718-837-1179

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RUBIN FRENKEL
Credential	:	M.D.
Telephone Number	:	718-837-4466

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	10/11/2010

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