=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003869009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN CARDIOLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 04/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1166 RIVER AVE SUITE 204
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-905-4142
-----------------------------------------------------
Fax | 732-905-4160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1166 RIVER AVE SUITE 204
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-905-4142
-----------------------------------------------------
Fax | 732-905-4160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOSHE BACHARACH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 73290541425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 46194
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------