Provider Demographics
NPI:1164605531
Name:MARTINSVILLE WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:MARTINSVILLE WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:IVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-271-1771
Mailing Address - Street 1:784 CHIMNEY ROCK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2272
Mailing Address - Country:US
Mailing Address - Phone:732-271-1771
Mailing Address - Fax:732-271-9477
Practice Address - Street 1:784 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE G
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2272
Practice Address - Country:US
Practice Address - Phone:732-271-1771
Practice Address - Fax:732-271-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05501700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty