Provider Demographics
NPI:1285024471
Name:OCEAN REHAB
Entity Type:Organization
Organization Name:OCEAN REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:347-603-5656
Mailing Address - Street 1:1911 AVENUE L
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5002
Mailing Address - Country:US
Mailing Address - Phone:347-603-5656
Mailing Address - Fax:
Practice Address - Street 1:1911 AVENUE L
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5002
Practice Address - Country:US
Practice Address - Phone:347-603-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty