Provider Demographics
NPI:1053471532
Name:OCEAN OTOLARYNGOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:OCEAN OTOLARYNGOLOGY ASSOCIATES PA
Other - Org Name:BRUCE W PETERS DO PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-281-0100
Mailing Address - Street 1:54 BEY LEA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2891
Mailing Address - Country:US
Mailing Address - Phone:732-281-0100
Mailing Address - Fax:732-281-0400
Practice Address - Street 1:54 BEY LEA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2891
Practice Address - Country:US
Practice Address - Phone:732-281-0100
Practice Address - Fax:732-281-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06567300207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037986Medicare ID - Type Unspecified
NJE92668Medicare UPIN