Provider Demographics
NPI:1770770661
Name:OCEAN MEDICAL DIAGNOSTICS P.C.
Entity type:Organization
Organization Name:OCEAN MEDICAL DIAGNOSTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYNGERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-677-7776
Mailing Address - Street 1:745 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1113
Mailing Address - Country:US
Mailing Address - Phone:718-677-7776
Mailing Address - Fax:718-859-5969
Practice Address - Street 1:745 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1113
Practice Address - Country:US
Practice Address - Phone:718-677-7776
Practice Address - Fax:718-859-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215638174400000X
NY197845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAA591Medicare PIN