Healthcare Provider Details

I. General information

NPI: 1285993956
Provider Name (Legal Business Name): OCEAN MEDICAL PLUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E 105TH ST SUITE 104
NEW YORK NY
10029-5000
US

IV. Provider business mailing address

315 E 105TH ST SUITE 104
NEW YORK NY
10029-5000
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-7800
  • Fax:
Mailing address:
  • Phone: 212-722-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number208907
License Number StateNY

VIII. Authorized Official

Name: DR. VADIM SURIKOV
Title or Position: OWNER
Credential: M.D.
Phone: 212-722-7800