Provider Demographics
NPI:1205882602
Name:ADVANCED OBSTETRIC & GYN LLC
Entity type:Organization
Organization Name:ADVANCED OBSTETRIC & GYN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-625-7002
Mailing Address - Street 1:4 WALTER E FORAN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4668
Mailing Address - Country:US
Mailing Address - Phone:908-284-5295
Mailing Address - Fax:908-806-3478
Practice Address - Street 1:4 WALTER E FORAN BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4664
Practice Address - Country:US
Practice Address - Phone:908-806-0080
Practice Address - Fax:908-806-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8597707Medicaid
2A6047OtherPTAN
NJ002785927001Medicaid