Provider Demographics
NPI:1487699153
Name:COMMUNITY SURGICAL OF SOUTHERN OCEAN
Entity type:Organization
Organization Name:COMMUNITY SURGICAL OF SOUTHERN OCEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-349-2990
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-0432
Mailing Address - Country:US
Mailing Address - Phone:609-597-2001
Mailing Address - Fax:
Practice Address - Street 1:37 NAUTILUS DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2448
Practice Address - Country:US
Practice Address - Phone:609-597-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1242900001Medicare ID - Type Unspecified