Provider Demographics
NPI:1225160831
Name:AIDA OB GYN ASSOCIATES CORPORATION
Entity Type:Organization
Organization Name:AIDA OB GYN ASSOCIATES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIOLAINE
Authorized Official - Middle Name:M-L-T
Authorized Official - Last Name:GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-378-3111
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207-0946
Mailing Address - Country:US
Mailing Address - Phone:973-378-3111
Mailing Address - Fax:973-378-9119
Practice Address - Street 1:2040 MILLBURN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3726
Practice Address - Country:US
Practice Address - Phone:973-378-3111
Practice Address - Fax:973-378-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06105200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7852703Medicaid
NJH06233Medicare UPIN
NJ032859NSVMedicare ID - Type Unspecified