Healthcare Provider Details

I. General information

NPI: 1689101487
Provider Name (Legal Business Name): OCEAN HEALTHCARE PCP-TUCKERTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W MAIN ST
TUCKERTON NJ
08087-2200
US

IV. Provider business mailing address

213 W MAIN ST
TUCKERTON NJ
08087-2200
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-4324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: AVROHOM MAIEROVITS
Title or Position: CONTROLLER
Credential:
Phone: 732-994-4324