Basic Information
| Provider Information | |||||||||
| NPI: | 1134144298 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB/GYN HEALTH CENTER ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 5TH AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121803340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182740476 | ||||||||
| FaxNumber: | 5182740497 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 5TH AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121803340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182740476 | ||||||||
| FaxNumber: | 5182740497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PADULA | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5182740476 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0015055 | 01 | NY | GHI | OTHER | 00705899 | 05 | NY | MEDICAID | 1102 | 01 | NY | CDPHP | OTHER |