Provider Demographics
NPI:1649496043
Name:THEODORE B LYGAS MD F A C S PA
Entity type:Organization
Organization Name:THEODORE B LYGAS MD F A C S PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LYGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-458-4600
Mailing Address - Street 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-458-4600
Mailing Address - Fax:732-458-3885
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-458-4600
Practice Address - Fax:732-458-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
744216Medicare ID - Type Unspecified