Provider Demographics
NPI:1033163696
Name:TOMS RIVER MEDICAL GROUP PA
Entity Type:Organization
Organization Name:TOMS RIVER MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-0325
Mailing Address - Street 1:334 COMMONS WAY
Mailing Address - Street 2:BUILDING C
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6428
Mailing Address - Country:US
Mailing Address - Phone:732-341-0325
Mailing Address - Fax:
Practice Address - Street 1:334 COMMONS WAY
Practice Address - Street 2:BUILDING C
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6428
Practice Address - Country:US
Practice Address - Phone:732-341-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2693607Medicaid
NJ526382Medicare ID - Type UnspecifiedGROUP ID