Provider Demographics
NPI:1295249100
Name:RIDGEWOODS OBSTETRICS & GYNECOLOGY
Entity type:Organization
Organization Name:RIDGEWOODS OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSKAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAWEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-513-1374
Mailing Address - Street 1:6605 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3334
Mailing Address - Country:US
Mailing Address - Phone:917-513-1374
Mailing Address - Fax:
Practice Address - Street 1:6605 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3334
Practice Address - Country:US
Practice Address - Phone:917-513-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264565261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03500552Medicaid