Provider Demographics
NPI:1689867749
Name:PHYSICIANS FOR WOMENS HEALTHCARE PA
Entity Type:Organization
Organization Name:PHYSICIANS FOR WOMENS HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-422-1200
Mailing Address - Street 1:315 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4896
Mailing Address - Country:US
Mailing Address - Phone:973-422-1200
Mailing Address - Fax:973-422-9169
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-422-1200
Practice Address - Fax:973-422-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036018Medicare PIN