Unknown Individual – Obstetrics & Gynecology Physician, NPI 1356413819

Obstetrics & Gynecology Physician

Unknown Individual is a healthcare provider. based in Perth amboy, New Jersey. specializing in Obstetrics & Gynecology Physician. They hold a License No. 25MA02238200 (NJ). The NPI Number for Unknown Individual is 1356413819

Main info

Organization

Inactive

65 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1356413819

Phone

(732) 826-3600

Address

511 NEW BRUNSWICK AVE

Deactivation Date

25 October 2023

Doctor Profile

Medical School Name

CHICAGO COLLEGE OF MEDICINE AND SURGERY

Secondary Phone

7328263600

Graduation Year

1961 (65 years ago)

PAC ID

4587737812

Group Practice PAC ID

6507962206

Professional Enrollment ID

I20080721000312

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

New Brunswick Avenue, Harbor Terrace, Perth Amboy, Middlesex County, New Jersey, 08861, United States
PERTH AMBOY, NJ 088613655
Phone: (732) 826-3600
Fax: (732) 826-5183
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 08861)

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Provider's Procedures

Unknown Individual performs procedures in Obstetrics & Gynecology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
OBSTETRICS/GYNECOLOGY	NJ	76830	Ultrasound pelvis through vagina	50	44

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 6507962206View full group profile

Name	Specialty	State
DR. JENNIFER FRANCES TRELA (MD)	Family Practice	NJ
DR. VINCENT MILAZZO (MD)	-	NJ
HELIO J MALINVERNI (MD)	-	NJ
MS. LEISHA A MAHONEY (CNM)	-	NJ
KAREN L KISS (NPC)	-	NJ
EVELYN CHU (MD)	Family Practice	NY
DEBORAH LORING (AGPCNP-BC)	-	NJ
DR. GEORGE J. SAVIANO (M.D.)	-	NJ
STEPHANIE SOUSSAN (APN)	-	NJ
Unknown Individual	-	NJ