MEDICARE: OCEAN ENDOCRINE SPECIALISTS LLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1508838434	OTHER		HORIZON

General Provider Information

NPI Number	:	1225716863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN ENDOCRINE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1255 ROUTE 70 STE 31S
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5973
Country	:	US
Telephone Number	:	732-908-2200
Fax Number	:	732-908-8111

Provider Business Practice Location Address
First Line	:	1255 ROUTE 70 STE 31S
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5973
Country	:	US
Telephone Number	:	732-908-2200
Fax Number	:	732-908-8111

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD VILLANUEVA
Credential	:	MD
Telephone Number	:	732-908-2200

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	04/07/2026

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