Healthcare Provider Details

I. General information

NPI: 1285861682
Provider Name (Legal Business Name): OCEAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2792 OCEAN AVE
BROOKLYN NY
11229-4708
US

IV. Provider business mailing address

2792 OCEAN AVE
BROOKLYN NY
11229-4708
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-7090
  • Fax: 718-648-1328
Mailing address:
  • Phone: 718-743-7090
  • Fax: 718-648-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STELLA ZAVELYUK
Title or Position: PRESIDENT
Credential: MD
Phone: 718-743-7090