Provider Demographics
NPI:1528088861
Name:FERLISE, VICTOR JOHN (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOHN
Last Name:FERLISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROUTE 37 W
Mailing Address - Street 2:RIVERWOOD 2 SUITE 1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6400
Mailing Address - Country:US
Mailing Address - Phone:732-914-1300
Mailing Address - Fax:732-914-0849
Practice Address - Street 1:67 ROUTE 37 W
Practice Address - Street 2:RIVERWOOD 2 SUITE 1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6400
Practice Address - Country:US
Practice Address - Phone:732-914-1300
Practice Address - Fax:732-914-0849
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424821208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7329141300OtherPHONE#