Provider Demographics
NPI:1578519674
Name:CENTER FOR GYNECOLOGIC ONCOLOGY & WOMEN'S HEALTH INC.
Entity Type:Organization
Organization Name:CENTER FOR GYNECOLOGIC ONCOLOGY & WOMEN'S HEALTH INC.
Other - Org Name:CENTER FOR GYNECOLOGIC ONCOLOGY AND WOMANS HEALTH INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-762-7270
Mailing Address - Street 1:120 IRVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1904
Mailing Address - Country:US
Mailing Address - Phone:973-762-7270
Mailing Address - Fax:973-762-1980
Practice Address - Street 1:120 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1904
Practice Address - Country:US
Practice Address - Phone:973-762-7270
Practice Address - Fax:973-762-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07363800207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9003703Medicaid
NJF27684Medicare UPIN
NJ9003703Medicaid