Healthcare Provider Details

I. General information

NPI: 1336124536
Provider Name (Legal Business Name): OCEAN MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BEACH 129TH ST
BELLE HARBOR NY
11694-1516
US

IV. Provider business mailing address

PO BOX 398
WOODMERE NY
11598-0398
US

V. Phone/Fax

Practice location:
  • Phone: 718-474-1000
  • Fax: 718-945-3987
Mailing address:
  • Phone: 718-474-1000
  • Fax: 718-945-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6021299
License Number StateNY

VIII. Authorized Official

Name: DR. MARK A RAIFMAN
Title or Position: OWNER
Credential: MD
Phone: 718-474-1000