Provider Demographics
NPI:1326459371
Name:PHILADELPHIA WOMEN'S CENTER, INC.
Entity Type:Organization
Organization Name:PHILADELPHIA WOMEN'S CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-356-4025
Mailing Address - Street 1:601 CHAPEL AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1454
Mailing Address - Country:US
Mailing Address - Phone:856-356-4025
Mailing Address - Fax:856-356-4038
Practice Address - Street 1:777 APPLETREE ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1526
Practice Address - Country:US
Practice Address - Phone:215-574-3590
Practice Address - Fax:215-574-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001787012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101798790 0002Medicaid