Provider Demographics
NPI:1700805876
Name:OCEAN BREEZE MEDICAL P.C.
Entity type:Organization
Organization Name:OCEAN BREEZE MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEKHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-332-7916
Mailing Address - Street 1:3111 OCEAN PKWY
Mailing Address - Street 2:APT 7B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8400
Mailing Address - Country:US
Mailing Address - Phone:718-332-7916
Mailing Address - Fax:718-332-7918
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-332-7916
Practice Address - Fax:718-332-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1981431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03027814Medicaid
NY03027814Medicaid