Provider Demographics
NPI:1316213994
Name:SOMERSET OBGYN ASSOCIATION
Entity Type:Organization
Organization Name:SOMERSET OBGYN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERDUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-725-8987
Mailing Address - Street 1:PO BOX 6130
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-0130
Mailing Address - Country:US
Mailing Address - Phone:908-725-8987
Mailing Address - Fax:
Practice Address - Street 1:1 NEW AMWELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-5006
Practice Address - Country:US
Practice Address - Phone:908-874-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096024Medicare PIN