Provider Demographics
NPI:1356643134
Name:HACKETTSTOWN MIDWIVES
Entity Type:Organization
Organization Name:HACKETTSTOWN MIDWIVES
Other - Org Name:MIDWIVES OF NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:908-399-5059
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-0253
Mailing Address - Country:US
Mailing Address - Phone:908-509-1801
Mailing Address - Fax:732-301-9252
Practice Address - Street 1:57 US HIGHWAY 46 STE 300
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-509-1801
Practice Address - Fax:732-301-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00501100363L00000X
NJ25ME00035501367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty