Provider Demographics
NPI:1801968425
Name:UMDNJ RWJ REPRODUCTIVE ENDOCRINOLOGY
Entity type:Organization
Organization Name:UMDNJ RWJ REPRODUCTIVE ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-212-0061
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:303 GEORGE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2020
Practice Address - Country:US
Practice Address - Phone:732-235-7301
Practice Address - Fax:732-235-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8468702Medicaid
NJ046343Medicare ID - Type Unspecified
NJ046343PQZMedicare PIN