=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427085430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN COUNTY MEDICAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 849 WEST BAY AVENUE SUITE 7
-----------------------------------------------------
City | BARNEGAT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08005-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-660-0900
-----------------------------------------------------
Fax | 609-660-1118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 849 WEST BAY AVENUE SUITE 7
-----------------------------------------------------
City | BARNEGAT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08005-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-660-0900
-----------------------------------------------------
Fax | 609-660-1118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VINCENT C GUIDA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 609-660-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MB61135
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------