Provider Demographics
NPI:1558700476
Name:PILGRIM GYNECOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PILGRIM GYNECOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-746-1500
Mailing Address - Street 1:393 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3741
Mailing Address - Country:US
Mailing Address - Phone:973-746-1500
Mailing Address - Fax:973-746-0955
Practice Address - Street 1:393 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3741
Practice Address - Country:US
Practice Address - Phone:973-746-1500
Practice Address - Fax:973-746-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04202700207VG0400X
NJ25MA03145400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty