Provider Demographics
NPI:1568467934
Name:WOMEN'S HEALTHCARE OF NE PA. PC
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE OF NE PA. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-253-3005
Mailing Address - Street 1:110 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2023
Mailing Address - Country:US
Mailing Address - Phone:570-253-3005
Mailing Address - Fax:570-253-0181
Practice Address - Street 1:110 PARK ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2023
Practice Address - Country:US
Practice Address - Phone:570-253-3005
Practice Address - Fax:570-253-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01204044Medicaid
PA0012190800001Medicaid
NY01204044Medicaid