Healthcare Provider Details

I. General information

NPI: 1740325901
Provider Name (Legal Business Name): E K OCEAN DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 OCEAN PKWY LOBBY 1
BROOKLYN NY
11218
US

IV. Provider business mailing address

514 OCEAN PKWY LOBBY 1
BROOKLYN NY
11218
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-2330
  • Fax: 718-435-5967
Mailing address:
  • Phone: 718-435-2330
  • Fax: 718-435-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number047095
License Number StateNY

VIII. Authorized Official

Name: ELIZABETH KOWALCZYK
Title or Position: DIRECTOR
Credential: DDS
Phone: 718-435-2330