Provider Demographics
NPI:1477894483
Name:SACRED FAMILY GYNECOLOGY LLC
Entity Type:Organization
Organization Name:SACRED FAMILY GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-871-4000
Mailing Address - Street 1:54 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3514
Mailing Address - Country:US
Mailing Address - Phone:201-871-4000
Mailing Address - Fax:201-608-6938
Practice Address - Street 1:54 S DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3514
Practice Address - Country:US
Practice Address - Phone:201-871-4000
Practice Address - Fax:201-608-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08405100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty