Provider Demographics
NPI:1396877007
Name:BERGEN WOMEN OB GYN ASSOC
Entity type:Organization
Organization Name:BERGEN WOMEN OB GYN ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MRUDULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-262-8777
Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:STE 21
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-262-8777
Mailing Address - Fax:201-262-4693
Practice Address - Street 1:466 OLD HOOK RD
Practice Address - Street 2:STE 21
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-262-8777
Practice Address - Fax:201-262-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
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
BE422376Medicare ID - Type Unspecified