Provider Demographics
NPI:1164979092
Name:URGYN WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:URGYN WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSKILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-253-8111
Mailing Address - Street 1:615 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1903
Mailing Address - Country:US
Mailing Address - Phone:201-447-1700
Mailing Address - Fax:201-447-9386
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:201-447-1700
Practice Address - Fax:201-447-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty