Provider Demographics
NPI:1669460648
Name:HOLMDEL OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:HOLMDEL OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Other - Org Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-739-2500
Mailing Address - Street 1:704 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1519
Mailing Address - Country:US
Mailing Address - Phone:732-739-2500
Mailing Address - Fax:732-888-2778
Practice Address - Street 1:704 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1519
Practice Address - Country:US
Practice Address - Phone:732-739-2500
Practice Address - Fax:732-888-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0113665000OtherAMERIHEALTH
NJCN3013OtherRAILROAD MEDICARE
NJ0K03307OtherHEALTHNET
NJ3271005Medicaid
NJ526537Medicare PIN