Healthcare Provider Details

I. General information

NPI: 1720059934
Provider Name (Legal Business Name): WOODBRIDGE MEDICAL ASSOCIATES,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROUTE 9 N SUITE 302
WOODBRIDGE NJ
07095-1215
US

IV. Provider business mailing address

1000 ROUTE 9 N SUITE 302
WOODBRIDGE NJ
07095-1215
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-0036
  • Fax: 732-855-0112
Mailing address:
  • Phone: 732-634-0036
  • Fax: 732-855-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY O'DONNELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-634-0036