Provider Demographics
NPI:1962453571
Name:ENGLEWOOD OBGYN WOMENS GROUP, P.A.
Entity type:Organization
Organization Name:ENGLEWOOD OBGYN WOMENS GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:YOON-JUNG
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-6190
Mailing Address - Street 1:286 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2405
Mailing Address - Country:US
Mailing Address - Phone:201-569-6190
Mailing Address - Fax:201-569-6940
Practice Address - Street 1:286 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2405
Practice Address - Country:US
Practice Address - Phone:201-569-6190
Practice Address - Fax:201-569-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
066235Medicare ID - Type Unspecified