NPIMap

Organization Active NPI

Willowbrook Obstetrics and Gynecology LLC

  • Obstetrics & Gynecology Physician
  • Wayne, NJ
National Provider Identifier
1790820496
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
25MA05001400 Issued in NJ
Legal business name
WILLOWBROOK OBSTETRICS AND GYNECOLOGY LLC
Practice address
57 Willowbrook Blvd
Suite 301
Wayne, NJ 07470-7045
Phone
(973) 754-4075
Fax
(973) 256-6523
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Roger P Kierce, M.D.NPI 1740216605
Title
Manager
Phone
(973) 754-4975

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 25MA05001400 NJ Primary

Addresses

Primary practice location

57 Willowbrook Blvd
Suite 301
Wayne, NJ 07470-7045

Mailing address

57 Willowbrook Blvd.
Suite 301
Wayne, NJ 07470
Phone (973) 754-4075

Other identifiers 1

IdentifierTypeStateIssuer
5231507MedicaidNH

National Provider Directory

National Provider Directory

Locations

57 Willowbrook Blvd
Ste 301
Wayne, NJ 07470
Phone (973) 754-4075

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790820496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD.",
            "address_2": "SUITE 301",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "07470",
            "telephone_number": "973-754-4075",
            "fax_number": "973-256-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD",
            "address_2": "SUITE 301",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707045",
            "telephone_number": "973-754-4075",
            "fax_number": "973-256-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWBROOK OBSTETRICS AND GYNECOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIERCE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "973-754-4975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA05001400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5231507",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.