Healthcare Provider Details

I. General information

NPI: 1194226373
Provider Name (Legal Business Name): OCEAN HEALTH INITIATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 JACKSON ST STE E
FREEHOLD NJ
07728-2476
US

IV. Provider business mailing address

3600 ROUTE 66 STE 400
NEPTUNE NJ
07753-2605
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-6655
  • Fax:
Mailing address:
  • Phone: 732-363-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE VARIO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 732-363-6655