Provider Demographics
NPI:1497874804
Name:NORTH JERSEY OB GYN, P.C.
Entity Type:Organization
Organization Name:NORTH JERSEY OB GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-689-9968
Mailing Address - Street 1:1 W RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-689-9968
Mailing Address - Fax:201-689-9978
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-689-9968
Practice Address - Fax:201-689-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ005640Medicare ID - Type Unspecified