Provider Demographics
NPI:1548249063
Name:HUSSERL, TOBY B (MD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:B
Last Name:HUSSERL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2164 HIGHWAY 35
Mailing Address - Street 2:BLDG A
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1013
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-449-4271
Practice Address - Street 1:2164 HIGHWAY 35
Practice Address - Street 2:BLDG A
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1013
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-449-4271
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA47634207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC32729Medicare UPIN
1017220001Medicare NSC
NJ537275BC1Medicare PIN