Provider Demographics
NPI:1467597682
Name:OCEANSIDE MEDICAL, INC
Entity Type:Organization
Organization Name:OCEANSIDE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PERROTTA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:800-561-2809
Mailing Address - Street 1:11 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1732
Mailing Address - Country:US
Mailing Address - Phone:800-561-2809
Mailing Address - Fax:888-545-9245
Practice Address - Street 1:11 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1732
Practice Address - Country:US
Practice Address - Phone:800-561-2809
Practice Address - Fax:888-545-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5027790001Medicare NSC