MEDICARE: OCEAN MEDICAL PLAZA P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1093758336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN MEDICAL PLAZA P.C.

Provider Business Mailing Address
First Line	:	1724-1726 OCEAN AVE
Second Line	:	BSMT
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5401
Country	:	US
Telephone Number	:	718-258-2200
Fax Number	:	718-258-2756

Provider Business Practice Location Address
First Line	:	1724-1726 OCEAN AVE
Second Line	:	BSMT
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5401
Country	:	US
Telephone Number	:	718-258-2200
Fax Number	:	718-258-2756

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ILYA SMUGLIN
Credential	:
Telephone Number	:	718-258-2200

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/22/2020

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