Provider Demographics
NPI:1407999360
Name:SALUS OB GYN ASSOCIATES LLC
Entity Type:Organization
Organization Name:SALUS OB GYN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MRINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-490-0036
Mailing Address - Street 1:PO BOX 5604
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-5604
Mailing Address - Country:US
Mailing Address - Phone:973-589-8800
Mailing Address - Fax:973-589-8802
Practice Address - Street 1:341 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2611
Practice Address - Country:US
Practice Address - Phone:973-589-8800
Practice Address - Fax:973-589-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07786800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
25MA07786800OtherLIC
DO8587700OtherCDS
DO8587700OtherCDS