Provider Demographics
NPI:1174849053
Name:OAM PEDIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:OAM PEDIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-473-0356
Mailing Address - Street 1:886 COMMONS WAY BLDG H
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6430
Mailing Address - Country:US
Mailing Address - Phone:732-473-0356
Mailing Address - Fax:732-473-0359
Practice Address - Street 1:886 COMMONS WAY BLDG H
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6430
Practice Address - Country:US
Practice Address - Phone:732-473-0356
Practice Address - Fax:732-473-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0205231Medicaid