Provider Demographics
NPI:1376311514
Name:OCEAN AVENUE MEDICAL OFFICE P.C
Entity Type:Organization
Organization Name:OCEAN AVENUE MEDICAL OFFICE P.C
Other - Org Name:RAS MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SAEEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:347-962-2424
Mailing Address - Street 1:1199 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2042
Mailing Address - Country:US
Mailing Address - Phone:718-859-7446
Mailing Address - Fax:
Practice Address - Street 1:1199 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2042
Practice Address - Country:US
Practice Address - Phone:718-859-7446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty