Provider Demographics
NPI:1134144298
Name:OB/GYN HEALTH CENTER ASSOCIATES, LLP
Entity Type:Organization
Organization Name:OB/GYN HEALTH CENTER ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-274-0476
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3340
Mailing Address - Country:US
Mailing Address - Phone:518-274-0476
Mailing Address - Fax:518-274-0497
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3340
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0015055OtherGHI
NY00705899Medicaid
NY1102OtherCDPHP
NY1102OtherCDPHP