Provider Demographics
NPI:1144373846
Name:LADIES CHOICE OBSTETRICS & GYNECOLOGY PC
Entity type:Organization
Organization Name:LADIES CHOICE OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-404-1400
Mailing Address - Street 1:314 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4464
Mailing Address - Country:US
Mailing Address - Phone:609-404-1400
Mailing Address - Fax:
Practice Address - Street 1:314 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4464
Practice Address - Country:US
Practice Address - Phone:609-404-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04119400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0400334000OtherAMERIHEALTH
NJ=========OtherTAX ID
NJ026770Medicare ID - Type UnspecifiedGROUP NUMBER