Provider Demographics
NPI:1083472518
Name:OCEAN SPINE AND PAIN
Entity Type:Organization
Organization Name:OCEAN SPINE AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-678-6070
Mailing Address - Street 1:108 HOCKHOCKSON RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1813
Mailing Address - Country:US
Mailing Address - Phone:732-678-6070
Mailing Address - Fax:
Practice Address - Street 1:368 LAKEHURST RD STE 303
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7339
Practice Address - Country:US
Practice Address - Phone:732-678-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty