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General NPI Number Information
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NPI Number | 1538555958
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Entity Type | Organization
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Legal Business Name | ADVANCED GYNECOLOGY AND LAPAROSCOPY OF NORTH JERSEY, PC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 2025 HAMBURG TPKE STE C
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City | WAYNE
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State | NJ
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Zip | 07470-6250
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Country | US
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Telephone | 201-957-7220
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Fax | 201-977-6747
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Provider Business Mailing Address
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Address Line | 2025 HAMBURG TPKE STE C
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City | WAYNE
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State | NJ
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Zip | 07470-6250
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Country | US
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Telephone | 201-957-7220
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Fax | 201-977-6747
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAGHAYEGH MOGHADDAM DENOBLE
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Credential | MD
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Telephone | 973-769-0083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 25MA08748500
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License Number State | NJ
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