Surfside Recovery Services Inc.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00513700 Issued in NJ

Legal business name

SURFSIDE RECOVERY SERVICES INC.

Practice address

3 S Weymouth Ave
Ventnor City, NJ 08406-2980

Phone

(609) 709-0245

NPI assigned

Dec 31, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Ian L. Koch, MS, LCADC, CASNPI 1851808802

Title

Executive Director

Phone

(609) 709-0244

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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

• Ian Koch, MS, LCADC, CAS

  • Addiction (Substance Use Disorder) Counselor
  • Ventnor City, NJ
  • NPI 1851808802
  NPD Authorized official
• Erica Lee Lapid, MS, LPC, LCADC, NCCP

  • Professional Counselor
  • Ventnor City, NJ
  • NPI 1770952467

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1514678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514678400000",
    "number": "1699282525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 EDGEWOOD DR",
            "city": "SOMERS POINT",
            "state": "NJ",
            "postal_code": "082441613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 S WEYMOUTH AVE",
            "city": "VENTNOR CITY",
            "state": "NJ",
            "postal_code": "084062980",
            "telephone_number": "609-709-0245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE RECOVERY SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-31",
        "last_updated": "2017-12-31",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "609-709-0244",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LCADC, CAS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00214900",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00513700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Ventnor City, NJ
• Providers in Ventnor City, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.