Provider Demographics
NPI:1568669588
Name:OBSTETRICS AND GYNECOLOGICAL ASSOCIATES OF TENAFLY
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGICAL ASSOCIATES OF TENAFLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-569-3300
Mailing Address - Street 1:TWO DEAN DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2765
Mailing Address - Country:US
Mailing Address - Phone:201-569-3300
Mailing Address - Fax:201-569-7649
Practice Address - Street 1:TWO DEAN DRIVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2765
Practice Address - Country:US
Practice Address - Phone:201-569-3300
Practice Address - Fax:201-569-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
083884Medicare PIN
NJ1568669588Medicare NSC