Provider Demographics
NPI:1487712568
Name:OCEAN NEUROSURGICAL
Entity type:Organization
Organization Name:OCEAN NEUROSURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAZDAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-6556
Mailing Address - Street 1:1530 HIGHWAY 88 W
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-458-6556
Mailing Address - Fax:732-458-3267
Practice Address - Street 1:1530 HIGHWAY 88 W
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-6556
Practice Address - Fax:732-458-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA22770207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2853906Medicaid
C61206Medicare UPIN
018764Medicare ID - Type Unspecified