Provider Demographics
NPI:1578962916
Name:BLUE RIVER WOMEN'S HEALTH PA
Entity Type:Organization
Organization Name:BLUE RIVER WOMEN'S HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHILAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-436-5371
Mailing Address - Street 1:12-45 RIVER RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1812
Mailing Address - Country:US
Mailing Address - Phone:973-209-0322
Mailing Address - Fax:855-302-5570
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:STE 506 FIRST FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1524
Practice Address - Country:US
Practice Address - Phone:973-500-2399
Practice Address - Fax:855-302-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07788200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty