Provider Demographics
NPI:1386820173
Name:RENAISSANCE GYNECOLOGY & INFERTILITY CENTER
Entity Type:Organization
Organization Name:RENAISSANCE GYNECOLOGY & INFERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN-BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-668-9900
Mailing Address - Street 1:PO BOX 7245
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-7245
Mailing Address - Country:US
Mailing Address - Phone:908-668-9900
Mailing Address - Fax:908-668-9922
Practice Address - Street 1:4 PROGRESS ST STE B4
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:908-668-9900
Practice Address - Fax:908-668-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043354Medicaid
NJ086527Medicare PIN