1962721290 NPI number — OCEAN MEDICAL IMAGING ASSOCIATES

Table of content: (NPI 1962721290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962721290 NPI number — OCEAN MEDICAL IMAGING ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN MEDICAL IMAGING ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962721290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 MULE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-286-6333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TRIOLO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
732-286-6333

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0085217000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0K8999 . This is a "CARECORENATL-HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 114703500 . This is a "US DEPT OF LABOR OWCP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0036826 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0074860 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: S10849 . This is a "AMERICAN IMAGING MNGT" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1042231 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3342000 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0K8999 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 44N055 . This is a "CARECORENATIONAL- AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: ANC696 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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