=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881867190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN SURGICAL ASSOCIAT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 04/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 NAUTILUS DR SUITE 2
-----------------------------------------------------
City | MANAHAWKIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08050-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-597-6072
-----------------------------------------------------
Fax | 609-597-5255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 NAUTILUS DR SUITE 2
-----------------------------------------------------
City | MANAHAWKIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08050-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-597-6072
-----------------------------------------------------
Fax | 609-597-5255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CARROLL CAHILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-597-6072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MA035943
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------