Provider Demographics
NPI:1518205814
Name:WOMENS HEALTH PRACTICE LLC
Entity Type:Organization
Organization Name:WOMENS HEALTH PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDLINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:NMW
Authorized Official - Phone:646-388-4702
Mailing Address - Street 1:436 FORT WASHINGTON AVE
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3507
Mailing Address - Country:US
Mailing Address - Phone:646-388-4702
Mailing Address - Fax:
Practice Address - Street 1:436 FORT WASHINGTON AVE
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3507
Practice Address - Country:US
Practice Address - Phone:646-388-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty