Provider Demographics
NPI:1215288386
Name:HIGH RISK PREGNANCY CENTER OF NEW JERSEY P.C.
Entity type:Organization
Organization Name:HIGH RISK PREGNANCY CENTER OF NEW JERSEY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBALAVANER
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-753-5771
Mailing Address - Street 1:908 OAK TREE AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5100
Mailing Address - Country:US
Mailing Address - Phone:908-753-5771
Mailing Address - Fax:908-753-2473
Practice Address - Street 1:1 AUER CT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5823
Practice Address - Country:US
Practice Address - Phone:732-390-1020
Practice Address - Fax:732-390-8035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH RISK PREGNANCY CENTER OF NEW JERSEY P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53719174400000X
NJMA44629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679634968OtherNPI
NJ1477662013OtherNPI