Provider Demographics
NPI:1467560938
Name:BERGEN-PASSAIC WOMENS HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BERGEN-PASSAIC WOMENS HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-891-3336
Mailing Address - Street 1:258 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-891-3336
Mailing Address - Fax:201-891-0627
Practice Address - Street 1:258 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481
Practice Address - Country:US
Practice Address - Phone:201-891-3336
Practice Address - Fax:201-891-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
024475Medicare ID - Type Unspecified