Provider Demographics
NPI:1912122011
Name:WAYNE OB GYN LLC
Entity Type:Organization
Organization Name:WAYNE OB GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:REIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-694-2222
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-0363
Mailing Address - Country:US
Mailing Address - Phone:973-694-2222
Mailing Address - Fax:973-694-5184
Practice Address - Street 1:7 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435-1452
Practice Address - Country:US
Practice Address - Phone:973-694-2222
Practice Address - Fax:973-694-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096367Medicare ID - Type Unspecified