Provider Demographics
NPI:1801938279
Name:COMMUNITY OB GYN ASSOCIATES
Entity type:Organization
Organization Name:COMMUNITY OB GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-986-5123
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-0469
Mailing Address - Country:US
Mailing Address - Phone:845-986-5123
Mailing Address - Fax:845-986-1488
Practice Address - Street 1:15 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1028
Practice Address - Country:US
Practice Address - Phone:845-986-1523
Practice Address - Fax:845-986-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC30733OtherHEALTHNET
NY0202210OtherGHI PPO
NY10856OtherWELLCARE
NY903803OtherAETNA HEALTH PLANS HMO
NY69941OtherMVP HEALTH PLANS
NY01814699Medicaid
NYE62394Medicare UPIN
NY01814699Medicaid