Provider Demographics
NPI:1124532064
Name:INTEGRATIVE OBGYN MEDICAL LLC
Entity type:Organization
Organization Name:INTEGRATIVE OBGYN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-487-8600
Mailing Address - Street 1:21 MCWILLIAMS PL # JC
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1609
Mailing Address - Country:US
Mailing Address - Phone:201-691-8664
Mailing Address - Fax:201-487-8601
Practice Address - Street 1:21 MCWILLIAMS PL # JC
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1609
Practice Address - Country:US
Practice Address - Phone:201-691-8664
Practice Address - Fax:201-487-8601
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
NJMA70956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty