Provider Demographics
NPI:1447622915
Name:GARDEN STATE OBGYN
Entity type:Organization
Organization Name:GARDEN STATE OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-424-3323
Mailing Address - Street 1:2401 E EVESHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9590
Mailing Address - Country:US
Mailing Address - Phone:856-424-3323
Mailing Address - Fax:
Practice Address - Street 1:2401 E EVESHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9590
Practice Address - Country:US
Practice Address - Phone:856-424-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00597000364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's HealthGroup - Single Specialty