Provider Demographics
NPI:1275571242
Name:PROSPECT WOMEN'S MEDICAL CENTER
Entity Type:Organization
Organization Name:PROSPECT WOMEN'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-1600
Mailing Address - Street 1:120 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2256
Mailing Address - Country:US
Mailing Address - Phone:201-342-1600
Mailing Address - Fax:
Practice Address - Street 1:120 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2256
Practice Address - Country:US
Practice Address - Phone:201-342-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02186100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ490858OtherGROUP AETNA #
NJCB7339OtherGROUP RAILROAD MEDICARE #
NJ1323830001Medicare NSC
NJCB7339OtherGROUP RAILROAD MEDICARE #