MEDICARE: OCEAN RENAL CARE PC

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	207RN0300X	Nephrology Physician	210753	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE5308	OTHER	NY	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1265570402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN RENAL CARE PC

Provider Business Mailing Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4902
Country	:	US
Telephone Number	:	718-996-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 WEST BRIGHTON AVE
Second Line	:	103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4901
Country	:	US
Telephone Number	:	718-996-2230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIE BENTSIANOV
Credential	:	MD
Telephone Number	:	718-996-3360

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/17/2014

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Directions to “OCEAN RENAL CARE PC ” Practice Location

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