Provider Demographics
NPI:1013011543
Name:OB-GYN PROFESSIONAL ASSOCIATES PC
Entity Type:Organization
Organization Name:OB-GYN PROFESSIONAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE CHOLNOKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-325-9710
Mailing Address - Street 1:166 W BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3661
Mailing Address - Country:US
Mailing Address - Phone:203-325-9710
Mailing Address - Fax:203-325-0176
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-325-9710
Practice Address - Fax:203-325-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010025249CT01OtherANTHEM
CT2080384OtherAETNA
CT2V5971OtherHEALTHNET
CT025249OtherCONNECTICARE
CTZS008OtherOXFORD
CT160000738Medicaid
CT2080384OtherAETNA
CTZS008OtherOXFORD
CT=========OtherCIGNA
CT160000738Medicaid
CT025249OtherCONNECTICARE
CT=========OtherPHCS