Provider Demographics
NPI:1720059934
Name:WOODBRIDGE MEDICAL ASSOCIATES,P.A.
Entity type:Organization
Organization Name:WOODBRIDGE MEDICAL ASSOCIATES,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-634-0036
Mailing Address - Street 1:1000 ROUTE 9 N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1215
Mailing Address - Country:US
Mailing Address - Phone:732-634-0036
Mailing Address - Fax:732-855-0112
Practice Address - Street 1:1000 ROUTE 9 N
Practice Address - Street 2:SUITE 302
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1215
Practice Address - Country:US
Practice Address - Phone:732-634-0036
Practice Address - Fax:732-855-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3942OtherAETNA
=========OtherHORIZON BLUE SHIELD
0049913Medicare ID - Type Unspecified
3942OtherAETNA