Provider Demographics
NPI:1538102876
Name:WOMENS OB GYN PC
Entity Type:Organization
Organization Name:WOMENS OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-342-1191
Mailing Address - Street 1:205 BROWERTOWN RD
Mailing Address - Street 2:STE 105-106
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:201-342-1191
Mailing Address - Fax:201-342-1195
Practice Address - Street 1:205 BROWERTOWN RD
Practice Address - Street 2:STE 105-106
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:201-342-1191
Practice Address - Fax:201-342-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7170700Medicaid
NJ7170700Medicaid