Provider Demographics
NPI:1538563119
Name:OCEAN CARDIOVASCULAR, LLC
Entity type:Organization
Organization Name:OCEAN CARDIOVASCULAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASQUARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-505-9005
Mailing Address - Street 1:25 MULE RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5035
Mailing Address - Country:US
Mailing Address - Phone:732-505-9005
Mailing Address - Fax:732-505-9919
Practice Address - Street 1:25 MULE RD
Practice Address - Street 2:SUITE B2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5035
Practice Address - Country:US
Practice Address - Phone:732-505-9005
Practice Address - Fax:732-505-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07278500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050744Medicare PIN