Premier OB/GYN LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

25MA07375800 Issued in NJ

Legal business name

PREMIER OB/GYN LLC

Practice address

135 Bloomfield Ave
Suite L
Bloomfield, NJ 07003-5902

Phone

(973) 429-2209

Fax

(973) 429-2210

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Decca Mohammed, MD

Title

MD

Phone

(973) 429-2209

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gloria O Odoemena, RN,C, MS, WHNP-BC

  • Women's Health Nurse Practitioner
  • Bloomfield, NJ
  • NPI 1386961761
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1336313113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 BLOOMFIELD AVE",
            "address_2": "SUITE L",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070035902",
            "telephone_number": "973-429-2209",
            "fax_number": "973-429-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 BLOOMFIELD AVE",
            "address_2": "SUITE L",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070035902",
            "telephone_number": "973-429-2209",
            "fax_number": "973-429-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER OB/GYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "MOHAMMED",
        "authorized_official_first_name": "DECCA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "973-429-2209",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA07375800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002453",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Obstetrics & Gynecology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.