Provider Demographics
NPI:1255380283
Name:OCEAN GYNECOLOGICAL & OBSTETRICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:OCEAN GYNECOLOGICAL & OBSTETRICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FABRICANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-364-8000
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 797
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:732-557-7109
Practice Address - Street 1:475 ROUTE 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-364-8000
Practice Address - Fax:732-364-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2664500Medicaid
NJ2664500Medicaid