Provider Demographics
NPI:1700186988
Name:OB/GYN WOMEN'S WELLNESS PC
Entity Type:Organization
Organization Name:OB/GYN WOMEN'S WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-272-3136
Mailing Address - Street 1:1040 CLIFTON AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3511
Mailing Address - Country:US
Mailing Address - Phone:973-272-3136
Mailing Address - Fax:973-547-9144
Practice Address - Street 1:1040 CLIFTON AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3511
Practice Address - Country:US
Practice Address - Phone:973-272-3136
Practice Address - Fax:973-547-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08255600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0256463Medicaid