Healthcare Provider Details

I. General information

NPI: 1144291261
Provider Name (Legal Business Name): OCEAN SURGICAL PAVILION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 HIGHWAY 35 SUITE 9
OAKHURST NJ
07755-2765
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: L&C
NASHVILLE TN
37215-6103
US

V. Phone/Fax

Practice location:
  • Phone: 732-517-0060
  • Fax: 732-380-1965
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6124003
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: JEFFREY E. SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283