Provider Demographics
NPI:1043558471
Name:PERINATAL & GYNECOLOGICAL SONOGRAPHY SERVICES, LLC
Entity Type:Organization
Organization Name:PERINATAL & GYNECOLOGICAL SONOGRAPHY SERVICES, LLC
Other - Org Name:THE GENESIS OB/GYN ULTRASOUND GROUP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-762-4805
Mailing Address - Street 1:233 ROCK RD # 208
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1708
Mailing Address - Country:US
Mailing Address - Phone:973-762-4805
Mailing Address - Fax:201-326-5613
Practice Address - Street 1:1860 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2905
Practice Address - Country:US
Practice Address - Phone:973-762-4805
Practice Address - Fax:201-326-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06233200207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty