Provider Demographics
NPI:1528117207
Name:LYGAS, THEODORE B (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:B
Last Name:LYGAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-458-4600
Mailing Address - Fax:732-458-3885
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 5A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-4600
Practice Address - Fax:732-458-3885
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA028906022086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C53795Medicare UPIN
186003DAHMedicare ID - Type Unspecified