MEDICARE: OCEAN RENAL ASSOCIATES, P.A.

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA9701	OTHER		RAILROAD MEDICARE NUMBER

General Provider Information

NPI Number	:	1740214204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN RENAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	210 JACK MARTIN BLVD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-7771
Country	:	US
Telephone Number	:	732-458-5067
Fax Number	:	732-458-4962

Provider Business Practice Location Address
First Line	:	1617 ROUTE 88 W
Second Line	:	SUITE D-1
City	:	BRICK
State	:	NJ
Zip	:	08724-3010
Country	:	US
Telephone Number	:	732-458-5067
Fax Number	:	732-458-4962

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. JOSE I IGLESIAS
Credential	:	D.O.
Telephone Number	:	732-458-5067

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/18/2016

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