Provider Demographics
NPI:1093096554
Name:ATLANTIC OB/GYN ASSOCIATES ,PC
Entity Type:Organization
Organization Name:ATLANTIC OB/GYN ASSOCIATES ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-202-7458
Mailing Address - Street 1:1631 ROUTE 88 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3048
Mailing Address - Country:US
Mailing Address - Phone:732-202-7458
Mailing Address - Fax:732-202-7459
Practice Address - Street 1:1631 ROUTE 88 W
Practice Address - Street 2:SUITE A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3048
Practice Address - Country:US
Practice Address - Phone:732-202-7458
Practice Address - Fax:732-202-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08279600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty