Provider Demographics
NPI:1437807096
Name:TRINITY FAMILY PRACTICE& GYNECOLOGY CENTER LLC
Entity Type:Organization
Organization Name:TRINITY FAMILY PRACTICE& GYNECOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-665-1906
Mailing Address - Street 1:411 43RD ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5049
Mailing Address - Country:US
Mailing Address - Phone:201-766-0377
Mailing Address - Fax:201-590-9175
Practice Address - Street 1:411 43RD ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5049
Practice Address - Country:US
Practice Address - Phone:201-766-0377
Practice Address - Fax:201-590-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty