1467648774 NPI number — OCEAN UROLOGY GROUP PA.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467648774 NPI number — OCEAN UROLOGY GROUP PA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN UROLOGY GROUP PA.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467648774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 ROUTE 37 WEST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08755-6434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-349-5200
Provider Business Mailing Address Fax Number:
732-349-5235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 RTE 37 W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-5059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-349-5200
Provider Business Practice Location Address Fax Number:
732-349-5235
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
EMMETT
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
732-349-5200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0721400010 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2643006 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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