Healthcare Provider Details

I. General information

NPI: 1376607937
Provider Name (Legal Business Name): COLTS NECK OBGYN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STATE ROUTE 34 S STE D-2
COLTS NECK NJ
07722-2415
US

IV. Provider business mailing address

PO BOX 240
COLTS NECK NJ
07722-0240
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-1616
  • Fax: 732-866-7962
Mailing address:
  • Phone: 732-431-1616
  • Fax: 732-866-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH CIPRIANO
Title or Position: PRESIDENT, CEO
Credential: MD
Phone: 732-431-1616