Provider Demographics
NPI:1447520903
Name:OCEANS OF HOPE MASTECTOMY BOUTIQUE
Entity type:Organization
Organization Name:OCEANS OF HOPE MASTECTOMY BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:732-557-4673
Mailing Address - Street 1:440 COMMONS WAY
Mailing Address - Street 2:BUILDING D
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6428
Mailing Address - Country:US
Mailing Address - Phone:732-557-4673
Mailing Address - Fax:732-557-4676
Practice Address - Street 1:440 COMMONS WAY
Practice Address - Street 2:BUILDING D
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6428
Practice Address - Country:US
Practice Address - Phone:732-557-4673
Practice Address - Fax:732-557-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier