Provider Demographics
NPI:1467648774
Name:OCEAN UROLOGY GROUP PA.
Entity Type:Organization
Organization Name:OCEAN UROLOGY GROUP PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:732-349-5200
Mailing Address - Street 1:780 ROUTE 37 WEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6434
Mailing Address - Country:US
Mailing Address - Phone:732-349-5200
Mailing Address - Fax:732-349-5235
Practice Address - Street 1:780 RTE 37 W
Practice Address - Street 2:SUITE 100
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-349-5200
Practice Address - Fax:732-349-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0721400010OtherRAILROAD MEDICARE
NJ2643006Medicaid
NJ428785Medicare PIN