Provider Demographics
NPI:1477501625
Name:CEDAR HILL OBSTETRICAL & GYNECOLOGICAL ASSOC PA
Entity Type:Organization
Organization Name:CEDAR HILL OBSTETRICAL & GYNECOLOGICAL ASSOC PA
Other - Org Name:NICHOLAS ASIMAKOPULOS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIMAKOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-447-6262
Mailing Address - Street 1:541 CEDAR HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-447-6262
Mailing Address - Fax:201-612-9228
Practice Address - Street 1:541 CEDAR HILL AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481
Practice Address - Country:US
Practice Address - Phone:201-447-6262
Practice Address - Fax:201-612-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02249000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS35530Medicare ID - Type Unspecified
C63312Medicare UPIN