Healthcare Provider Details

I. General information

NPI: 1467431536
Provider Name (Legal Business Name): MICHAEL WILLIAM O'HARA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 NJ ROUTE 37 WEST SUITE 330
TOMS RIVER NJ
08755-0772
US

IV. Provider business mailing address

71 MONTROSE RD
COLTS NECK NJ
07722-1641
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-2355
  • Fax: 833-661-9952
Mailing address:
  • Phone: 732-546-8113
  • Fax: 833-661-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB06250000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB06250000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MB06250000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: