Provider Demographics
NPI:1427424258
Name:O'CONNOR, GREGORY (DPT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 ROUTE 37 W STE 210
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5059
Mailing Address - Country:US
Mailing Address - Phone:327-736-7007
Mailing Address - Fax:
Practice Address - Street 1:780 ROUTE 37 W STE 210
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-736-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0062352255A2300X
NJ40QA01867400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer