Southern Ocean County Surgical Association, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA07937200 Issued in NJ

Legal business name

SOUTHERN OCEAN COUNTY SURGICAL ASSOCIATION, LLC

Practice address

44 Nautilus Dr
Suite 2B
Manahawkin, NJ 08050-2466

Phone

(609) 597-9477

Fax

(609) 489-0226

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sergey Grachev, M.D.NPI 1487629614

Title

Proprietor

Phone

(609) 597-9477

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sergey Grachev, M.D.

  • Surgery Physician
  • Manahawkin, NJ
  • NPI 1487629614
  Medicare reassignment NPD Authorized official
• Panagiotis George Psalidas, MD

  • Internal Medicine Physician
  • New York, NY
  • NPI 1114907730
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013016765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 NAUTILUS DR",
            "address_2": "SUITE 2B",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502466",
            "telephone_number": "609-597-9477",
            "fax_number": "609-489-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 NAUTILUS DR",
            "address_2": "SUITE 2B",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502466",
            "telephone_number": "609-597-9477",
            "fax_number": "609-489-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OCEAN COUNTY SURGICAL ASSOCIATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRACHEV",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "609-597-9477",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA07937200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Ocean Chiropractic
• Southern Ocean Co Radiation Oncology
• Southern Ocean County Dialysis Clinic, LLC
• Southern Ocean County Hospital
• Southern Ocean County Hospital
• Southern Ocean Oral Surgery & Implant Center, Inc.
• Southern Ocean Osic, Inc
• Southern Ocean Otolaryngology,PA
• Southern Ocean Pediatric Associates, P.C.
• Southern Ocean Pediatrics and Family Medicine

• Surgery Physician in Manahawkin, NJ
• Providers in Manahawkin, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.