Healthcare Provider Details

I. General information

NPI: 1730182023
Provider Name (Legal Business Name): OCEAN HOME HEALTH SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RIVERSIDE DR UNIT 11
PINE BROOK NJ
07058-9391
US

IV. Provider business mailing address

555 E NORTH LN STE 5075
CONSHOHOCKEN PA
19428-2490
US

V. Phone/Fax

Practice location:
  • Phone: 973-221-8136
  • Fax: 762-961-9897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WENDY RUSSALESI
Title or Position: CCO
Credential:
Phone: 484-246-9499