Healthcare Provider Details

I. General information

NPI: 1609373778
Provider Name (Legal Business Name): OCEAN AVE MEDICAL AND CARDIOREHAB P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 OCEAN AVE
EAST ROCKAWAY NY
11518-1208
US

IV. Provider business mailing address

510 OCEAN AVE
EAST ROCKAWAY NY
11518-1208
US

V. Phone/Fax

Practice location:
  • Phone: 516-399-2225
  • Fax: 516-399-2227
Mailing address:
  • Phone: 516-399-2225
  • Fax: 516-399-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number122512
License Number StateNY

VIII. Authorized Official

Name: MS. CLAIRE M GILVARY
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-527-6529