Provider Demographics
NPI:1710320239
Name:HOLISTIC OB/GYN, LLC
Entity Type:Organization
Organization Name:HOLISTIC OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM
Authorized Official - Phone:973-747-5217
Mailing Address - Street 1:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-6072
Mailing Address - Country:US
Mailing Address - Phone:973-747-5217
Mailing Address - Fax:973-396-8832
Practice Address - Street 1:1700 ROUTE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3928
Practice Address - Country:US
Practice Address - Phone:973-747-5217
Practice Address - Fax:973-396-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00038301367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty