=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912927120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN BREEZE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1817 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-987-2525
-----------------------------------------------------
Fax | 718-987-4316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1817 HYLAN BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-987-2525
-----------------------------------------------------
Fax | 718-987-4316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SUKETU PATEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 718-987-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | 027787
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------