Provider Demographics
NPI:1598016974
Name:WOMEN MEDICAL HEALTH CARE & DIAGNOSTICS PC
Entity Type:Organization
Organization Name:WOMEN MEDICAL HEALTH CARE & DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AJAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-739-3225
Mailing Address - Street 1:15915 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3935
Mailing Address - Country:US
Mailing Address - Phone:718-739-3225
Mailing Address - Fax:718-739-3238
Practice Address - Street 1:15915 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3935
Practice Address - Country:US
Practice Address - Phone:718-739-3225
Practice Address - Fax:718-739-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220777302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH36677Medicare UPIN