Provider Demographics
NPI:1821042011
Name:VINELAND OBSTETRICAL & GYNECOLOGIAL PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:VINELAND OBSTETRICAL & GYNECOLOGIAL PROFESSIONAL ASSOCIATION
Other - Org Name:WOMEN'S MEDICAL CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:PORTADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-0300
Mailing Address - Street 1:484 S BREWSTER RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7874
Mailing Address - Country:US
Mailing Address - Phone:856-696-0300
Mailing Address - Fax:856-696-2561
Practice Address - Street 1:484 S BREWSTER RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7874
Practice Address - Country:US
Practice Address - Phone:856-696-0300
Practice Address - Fax:856-696-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2598001Medicaid
NJ2598001Medicaid