Provider Demographics
NPI:1639238298
Name:UROGYNECOLOGY AND ADVANCED GYNECOLOGY MEDICAL GROUP PA
Entity Type:Organization
Organization Name:UROGYNECOLOGY AND ADVANCED GYNECOLOGY MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-275-0025
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-0272
Mailing Address - Country:US
Mailing Address - Phone:973-275-0025
Mailing Address - Fax:973-275-0026
Practice Address - Street 1:120 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1904
Practice Address - Country:US
Practice Address - Phone:973-275-0025
Practice Address - Fax:973-275-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0112089Medicaid
NJ0112089Medicaid
NJI28963Medicare UPIN