Healthcare Provider Details

I. General information

NPI: 1407953698
Provider Name (Legal Business Name): ATLANTIC SURGICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

IV. Provider business mailing address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-5445
  • Fax: 732-531-0225
Mailing address:
  • Phone: 732-531-5445
  • Fax: 732-531-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN09157900
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID J AVERBACH
Title or Position: BUSINESS MANAGER
Credential: MD
Phone: 732-531-5445