Professional OB GYN & Infertility Center of Irvington P a

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

MA37773 Issued in NJ

Legal business name

PROFESSIONAL OB GYN & INFERTILITY CENTER OF IRVINGTON P A

Practice address

566 Nye Ave
Irvington, NJ 07111-3241

Phone

(973) 399-9155

Fax

(973) 399-3936

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Suresh Radhakishin Thani, MD

Title

Doctor

Phone

(973) 399-9155

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1972655256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "566 NYE AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113241",
            "telephone_number": "973-399-9155",
            "fax_number": "973-399-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "566 NYE AVE",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113241",
            "telephone_number": "973-399-9155",
            "fax_number": "973-399-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL OB GYN & INFERTILITY CENTER OF IRVINGTON P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "THANI",
        "authorized_official_first_name": "SURESH",
        "authorized_official_middle_name": "RADHAKISHIN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "973-399-9155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NJ",
            "license": "MA37773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1490702",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.