Provider Demographics
NPI:1457502106
Name:JUST FOR U OBGYN
Entity Type:Organization
Organization Name:JUST FOR U OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PRIOLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-7269
Mailing Address - Street 1:301 S 8TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4000
Mailing Address - Country:US
Mailing Address - Phone:215-829-7269
Mailing Address - Fax:215-829-8707
Practice Address - Street 1:301 S 8TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4000
Practice Address - Country:US
Practice Address - Phone:215-829-7269
Practice Address - Fax:215-829-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060185-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016889830001Medicaid
PA0016889830001Medicaid