Healthcare Provider Details

I. General information

NPI: 1255252680
Provider Name (Legal Business Name): OCEAN WOUNDS RI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 DOUGLAS PIKE
SMITHFIELD RI
02917-2339
US

IV. Provider business mailing address

144 COLES WAY
LAKEWOOD NJ
08701-4885
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-2700
  • Fax:
Mailing address:
  • Phone: 845-901-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELYSSE LERNER
Title or Position: OWNER
Credential:
Phone: 845-901-7289