Provider Demographics
NPI:1508902040
Name:OCEAN MEDICAL MD PA
Entity Type:Organization
Organization Name:OCEAN MEDICAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-492-0900
Mailing Address - Street 1:3003 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-2653
Mailing Address - Country:US
Mailing Address - Phone:609-492-0900
Mailing Address - Fax:609-492-1347
Practice Address - Street 1:3003 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-2653
Practice Address - Country:US
Practice Address - Phone:609-492-0900
Practice Address - Fax:609-492-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011670Medicare PIN