Provider Demographics
NPI:1437100096
Name:OCEAN ADULT MEDICAL GROUP, L.L.C.
Entity Type:Organization
Organization Name:OCEAN ADULT MEDICAL GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-793-3236
Mailing Address - Street 1:64 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-2010
Mailing Address - Country:US
Mailing Address - Phone:732-793-7125
Mailing Address - Fax:732-830-3421
Practice Address - Street 1:64 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-2010
Practice Address - Country:US
Practice Address - Phone:732-793-7125
Practice Address - Fax:732-830-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8059004Medicaid
NJ2949154OtherAETNA
NJVP088COtherCIGNA
NJVP088COtherCIGNA
NJ2949154OtherAETNA
NJ=========0OtherHORIZON
NJ026937Medicare ID - Type UnspecifiedGROUP NUMBER