Provider Demographics
NPI:1609096890
Name:OCEAN PARK OB-GYN, PA
Entity Type:Organization
Organization Name:OCEAN PARK OB-GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-663-0030
Mailing Address - Street 1:1900 HWY 35 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2758
Mailing Address - Country:US
Mailing Address - Phone:732-663-0030
Mailing Address - Fax:732-663-0882
Practice Address - Street 1:1900 HWY 35 S
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2758
Practice Address - Country:US
Practice Address - Phone:732-663-0030
Practice Address - Fax:732-663-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD92560Medicare UPIN