Healthcare Provider Details

I. General information

NPI: 1104870740
Provider Name (Legal Business Name): ADVANCED OB-GYN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MAIN ST BOX 513
NEWTON NJ
07860-2023
US

IV. Provider business mailing address

PO BOX 513
NEWTON NJ
07860-0513
US

V. Phone/Fax

Practice location:
  • Phone: 973-383-7394
  • Fax:
Mailing address:
  • Phone: 973-383-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRED M SILVERBERG
Title or Position: MEMBER
Credential: M.D.
Phone: 973-635-2299