Healthcare Provider Details

I. General information

NPI: 1487458063
Provider Name (Legal Business Name): TWO OCEANS WELLNESS MEDICAL GROUP EAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RUSSEL AVE
OCEANPORT NJ
07757-1249
US

IV. Provider business mailing address

12 RUSSEL AVE
OCEANPORT NJ
07757-1249
US

V. Phone/Fax

Practice location:
  • Phone: 808-756-0739
  • Fax:
Mailing address:
  • Phone: 808-756-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINE I MCCOY
Title or Position: OWNER
Credential: MD
Phone: 808-756-0739