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General NPI Number Information
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NPI Number | 1649065913
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Entity Type | Organization
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Legal Business Name | TWO OCEANS WELLNESS MEDICAL GROUP WEST PC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 12 RUSSEL AVE.
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City | OCEANPORT
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State | NJ
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Zip | 07757
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Country | US
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Telephone | 808-756-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 12 RUSSEL AVE
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City | OCEANPORT
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State | NJ
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Zip | 07757-1249
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Country | US
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Telephone | 808-756-0739
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINE I MCCOY
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Credential | MD
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Telephone | 808-756-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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