Provider Demographics
NPI:1730458720
Name:OCEAN PARKWAY FAMILY PRACTICE ASSOCIATES PC
Entity Type:Organization
Organization Name:OCEAN PARKWAY FAMILY PRACTICE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-339-5749
Mailing Address - Street 1:514 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4648
Mailing Address - Country:US
Mailing Address - Phone:718-339-5749
Mailing Address - Fax:
Practice Address - Street 1:514 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4648
Practice Address - Country:US
Practice Address - Phone:718-339-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty