Provider Demographics
NPI:1609101062
Name:SPECIALIZING IN WOMEN'S CARE LLC
Entity Type:Organization
Organization Name:SPECIALIZING IN WOMEN'S CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSETTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEATAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-438-8860
Mailing Address - Street 1:22 SYLVAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2087
Mailing Address - Country:US
Mailing Address - Phone:201-438-8860
Mailing Address - Fax:201-438-1994
Practice Address - Street 1:22 SYLVAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2087
Practice Address - Country:US
Practice Address - Phone:201-438-8860
Practice Address - Fax:201-438-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH25493Medicare UPIN