Provider Demographics
NPI:1538555958
Name:ADVANCED GYNECOLOGY AND LAPAROSCOPY OF NORTH JERSEY, PC
Entity type:Organization
Organization Name:ADVANCED GYNECOLOGY AND LAPAROSCOPY OF NORTH JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAGHAYEGH
Authorized Official - Middle Name:MOGHADDAM
Authorized Official - Last Name:DENOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-769-0083
Mailing Address - Street 1:2025 HAMBURG TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6250
Mailing Address - Country:US
Mailing Address - Phone:201-957-7220
Mailing Address - Fax:201-977-6747
Practice Address - Street 1:2025 HAMBURG TPKE STE C
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6250
Practice Address - Country:US
Practice Address - Phone:201-957-7220
Practice Address - Fax:201-977-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08748500207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty