Healthcare Provider Details

I. General information

NPI: 1790011385
Provider Name (Legal Business Name): NORTH JERSEY GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ROUTE 23 SOUTH 1ST FLOOR
RIVERDALE NJ
07457
US

IV. Provider business mailing address

82 E. ALLENDALE ROAD SUITE 7
SADDLE RIVER NJ
07458
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-4200
  • Fax: 201-818-4888
Mailing address:
  • Phone: 201-236-8282
  • Fax: 201-236-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMB06730700
License Number StateNJ

VIII. Authorized Official

Name: PATTY BENDA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 201-236-8282