Provider Demographics
NPI:1184663577
Name:FIRSTCHOICE OBGYN GROUP, LLC
Entity Type:Organization
Organization Name:FIRSTCHOICE OBGYN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEDENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-441-9300
Mailing Address - Street 1:1115 CLIFTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3649
Mailing Address - Country:US
Mailing Address - Phone:201-441-9300
Mailing Address - Fax:201-525-1717
Practice Address - Street 1:1115 CLIFTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3649
Practice Address - Country:US
Practice Address - Phone:201-441-3000
Practice Address - Fax:201-525-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04250200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080579Medicare ID - Type Unspecified