Provider Demographics
NPI:1104152750
Name:OB/GYN SPECIAL CARE, LLC
Entity type:Organization
Organization Name:OB/GYN SPECIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LABIB
Authorized Official - Middle Name:EDISON
Authorized Official - Last Name:RIACHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-282-2000
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-282-2000
Mailing Address - Fax:908-282-6660
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-282-2000
Practice Address - Fax:908-282-6660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER OF ADVANCED PELVIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07007000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty