Provider Demographics
NPI:1477790491
Name:WAYNE OBSTETRICS & GYNECOLOGY ASSOCIATES P C
Entity Type:Organization
Organization Name:WAYNE OBSTETRICS & GYNECOLOGY ASSOCIATES P C
Other - Org Name:WAYNE OBSTETRICS & GYNECOLOGY ASSOCIATES P C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARUZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-3500
Mailing Address - Street 1:510 HAMBURG TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2025
Mailing Address - Country:US
Mailing Address - Phone:973-942-3500
Mailing Address - Fax:973-942-3881
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-942-3500
Practice Address - Fax:973-942-3881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE OBSTETRICS AND GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-13
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6133606Medicaid
NJ6133606Medicaid