Provider Demographics
NPI:1265781181
Name:OCEAN SPINE AND ADULT JOINT RECONSTRUCTION
Entity type:Organization
Organization Name:OCEAN SPINE AND ADULT JOINT RECONSTRUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:STURZEBECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-349-8454
Mailing Address - Street 1:530 LAKEHURST RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-349-8454
Mailing Address - Fax:732-341-0259
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-8454
Practice Address - Fax:732-341-0259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCEAN ORTHOPEDIC ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty