Provider Demographics
NPI:1093869802
Name:CENTRAL OCEAN EKG ASSOCIATES, PA
Entity Type:Organization
Organization Name:CENTRAL OCEAN EKG ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-557-7160
Mailing Address - Street 1:1433 HOOPER AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2200
Mailing Address - Country:US
Mailing Address - Phone:732-557-7160
Mailing Address - Fax:
Practice Address - Street 1:67 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6400
Practice Address - Country:US
Practice Address - Phone:732-557-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6008801Medicaid
NJ6008801Medicaid