=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790011385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH JERSEY GYNECOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2009
-----------------------------------------------------
Last Update Date | 11/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 ROUTE 23 SOUTH 1ST FLOOR
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-831-4200
-----------------------------------------------------
Fax | 201-818-4888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 E. ALLENDALE ROAD SUITE 7
-----------------------------------------------------
City | SADDLE RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-236-8282
-----------------------------------------------------
Fax | 201-236-0138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | PATTY BENDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-236-8282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MB06730700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------