=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437100096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN ADULT MEDICAL GROUP, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 GRAND CENTRAL AVE
-----------------------------------------------------
City | LAVALLETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08735-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-793-7125
-----------------------------------------------------
Fax | 732-830-3421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 GRAND CENTRAL AVE
-----------------------------------------------------
City | LAVALLETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08735-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-793-7125
-----------------------------------------------------
Fax | 732-830-3421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN DIRECTOR
-----------------------------------------------------
Name | CATHERINE A. FORRESTER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-793-3236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------