Provider Demographics
NPI:1588856942
Name:OCEAN AVENUE LAB SERVICES
Entity Type:Organization
Organization Name:OCEAN AVENUE LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-951-0333
Mailing Address - Street 1:1915 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6801
Mailing Address - Country:US
Mailing Address - Phone:718-951-0333
Mailing Address - Fax:718-951-3774
Practice Address - Street 1:1915 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6801
Practice Address - Country:US
Practice Address - Phone:718-951-0333
Practice Address - Fax:718-951-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222617291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory