1285853168 NPI number — WOMENS OWN OBGYN,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285853168 NPI number — WOMENS OWN OBGYN,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS OWN OBGYN,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285853168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 BUFF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENAFLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07670-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-541-6868
Provider Business Mailing Address Fax Number:
201-541-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-3578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-541-6868
Provider Business Practice Location Address Fax Number:
201-541-6869
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIEVES
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
201-541-6868

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  25MA07600700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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