Healthcare Provider Details

I. General information

NPI: 1992154678
Provider Name (Legal Business Name): METROPOLITAN OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 SPRINGFIELD AVE
MAPLEWOOD NJ
07040-3435
US

IV. Provider business mailing address

1973 SPRINGFIELD AVE
MAPLEWOOD NJ
07040-3435
US

V. Phone/Fax

Practice location:
  • Phone: 973-996-2600
  • Fax: 973-996-2601
Mailing address:
  • Phone: 973-996-2600
  • Fax: 973-996-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number26NR14879300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number25NJ00645500
License Number StateNJ

VIII. Authorized Official

Name: MRS. LYNN GRAFFEO
Title or Position: NURSE PRACTICE
Credential:
Phone: 973-996-2600