Provider Demographics
NPI:1225004443
Name:TOMS RIVER OBGYN ASSOC PA
Entity Type:Organization
Organization Name:TOMS RIVER OBGYN ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PESSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACOG
Authorized Official - Phone:732-244-9444
Mailing Address - Street 1:79 ROUTE 37 WEST
Mailing Address - Street 2:STE 101
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-9998
Mailing Address - Country:US
Mailing Address - Phone:732-244-9444
Mailing Address - Fax:732-244-9468
Practice Address - Street 1:79 ROUTE 37 WEST
Practice Address - Street 2:STE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-9998
Practice Address - Country:US
Practice Address - Phone:732-244-9444
Practice Address - Fax:732-244-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526680Medicare ID - Type Unspecified