Provider Demographics
NPI:1033290432
Name:OBGYN ASSOCIATES OF ENGLEWOOD
Entity Type:Organization
Organization Name:OBGYN ASSOCIATES OF ENGLEWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-0200
Mailing Address - Street 1:177 NORTH DEAN STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-569-0200
Mailing Address - Fax:201-569-8287
Practice Address - Street 1:177 NORTH DEAN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-569-0200
Practice Address - Fax:201-569-8287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBGYN ASSOCIATES OF ENGLEWOOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4719301Medicaid
NJC-58231Medicare UPIN
NJ4719301Medicaid