Healthcare Provider Details

I. General information

NPI: 1275824377
Provider Name (Legal Business Name): OCEAN BREEZE ASSOCIATES L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 DONGAN HILLS AVE STE 2B
STATEN ISLAND NY
10305-1224
US

IV. Provider business mailing address

235 DONGAN HILLS AVE STE 2B
STATEN ISLAND NY
10305-1224
US

V. Phone/Fax

Practice location:
  • Phone: 800-219-5920
  • Fax: 800-219-5921
Mailing address:
  • Phone: 718-979-5326
  • Fax: 718-979-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number030618
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUKETU PATEL
Title or Position: PRESIDENT
Credential:
Phone: 718-987-2525