NPIMap

Organization Active NPI

Woodbridge Medical Associates,P.a.

  • Gastroenterology Physician
  • Woodbridge, NJ
National Provider Identifier
1720059934
Registry record updated Feb 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
WOODBRIDGE MEDICAL ASSOCIATES,P.A.
Practice address
1000 Route 9 N
Suite 302
Woodbridge, NJ 07095-1215
Phone
(732) 634-0036
Fax
(732) 855-0112
NPI assigned
Jan 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2010

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

Authorized official

Name
Mary O'Donnell, M.D.NPI 1962473108
Title
President
Phone
(732) 634-0036

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X

Addresses

Primary practice location

1000 Route 9 N
Suite 302
Woodbridge, NJ 07095-1215

Mailing address

1000 Route 9 N
Suite 302
Woodbridge, NJ 07095-1215
Phone (732) 634-0036

Other identifiers 1

IdentifierTypeStateIssuer
3942OtherAETNA

Other names 1

  • Woodbridge Internal Medical Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041203000831 NJ Part B Supplier - Clinic/Group Practice 7618933383 Receives reassigned benefits from 8 practitioners
Practice locations: Woodbridge, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0107915Woodbridge Medical Associates, PA1000 Route 9 North, Woodbridge, NJ 07095Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory

Locations

1000 US Highway 9 N
Ste 302
Woodbridge, NJ 07095
Phone (732) 634-0036

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267056000000",
    "number": "1720059934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ROUTE 9 N",
            "address_2": "SUITE 302",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951215",
            "telephone_number": "732-634-0036",
            "fax_number": "732-855-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ROUTE 9 N",
            "address_2": "SUITE 302",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951215",
            "telephone_number": "732-634-0036",
            "fax_number": "732-855-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE MEDICAL ASSOCIATES,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-02-25",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-634-0036",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3942",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodbridge Internal Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.