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General NPI Number Information
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NPI Number | 1891892345
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Entity Type | Organization
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Legal Business Name | OCEAN PLASTIC SURGERY PA
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 413 LAKEHURST RD STE 301
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City | TOMS RIVER
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State | NJ
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Zip | 08755-7382
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Country | US
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Telephone | 732-255-7155
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Fax | 732-255-7455
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Provider Business Mailing Address
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Address Line | 413 LAKEHURST RD STE 301
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City | TOMS RIVER
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State | NJ
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Zip | 08755-7382
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Country | US
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Telephone | 732-255-7155
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Fax | 732-255-7455
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN EDWARD SMALL
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Credential | DO
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Telephone | 732-255-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB07162600
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License Number State | NJ
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