Provider Demographics
NPI:1699018200
Name:OCEANSIDE SURGERY, LLC
Entity Type:Organization
Organization Name:OCEANSIDE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MALCYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS, FCCP
Authorized Official - Phone:561-832-9440
Mailing Address - Street 1:2240 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6332
Mailing Address - Country:US
Mailing Address - Phone:561-832-9440
Mailing Address - Fax:561-832-9396
Practice Address - Street 1:2240 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6332
Practice Address - Country:US
Practice Address - Phone:561-832-9440
Practice Address - Fax:561-832-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1129732086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty