Healthcare Provider Details

I. General information

NPI: 1538102876
Provider Name (Legal Business Name): WOMENS OB GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BROWERTOWN RD STE 105-106
WEST PATERSON NJ
07424
US

IV. Provider business mailing address

205 BROWERTOWN RD STE 105-106
WEST PATERSON NJ
07424
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1191
  • Fax: 201-342-1195
Mailing address:
  • Phone: 201-342-1191
  • Fax: 201-342-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ANNA A COLLADO
Title or Position: PHYSICIAN PARTNER
Credential: DO
Phone: 201-342-1191