Provider Demographics
NPI:1427296003
Name:SUNRISE OBSTETRICS AND GYNECOLOGY, LLC
Entity type:Organization
Organization Name:SUNRISE OBSTETRICS AND GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRZYTULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-972-4200
Mailing Address - Street 1:831 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8288
Mailing Address - Country:US
Mailing Address - Phone:732-972-4200
Mailing Address - Fax:732-536-4288
Practice Address - Street 1:831 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8288
Practice Address - Country:US
Practice Address - Phone:732-972-4200
Practice Address - Fax:732-536-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9112901Medicaid
NJ150316Medicare PIN
NJ9112901Medicaid