=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104870740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED OB-GYN ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 MAIN ST BOX 513
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07860-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-383-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 513
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07860-0513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-383-7394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | FRED M SILVERBERG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 973-635-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------