Healthcare Provider Details

I. General information

NPI: 1457549065
Provider Name (Legal Business Name): OCEAN MANAGEMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 OCEAN AVE SUITE # 1
BROOKLYN NY
11235-3170
US

IV. Provider business mailing address

2818 OCEAN AVE SUITE # 1
BROOKLYN NY
11235-3170
US

V. Phone/Fax

Practice location:
  • Phone: 718-934-8484
  • Fax: 718-934-4267
Mailing address:
  • Phone: 718-934-8484
  • Fax: 718-934-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number208815
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL RISKEVICH
Title or Position: PRESIDENT
Credential: D.O
Phone: 718-934-8484