Provider Demographics
NPI:1710923123
Name:WOMENS HEALTHCARE OF SOUTH JERSEY
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-455-7017
Mailing Address - Street 1:20 MAGNOLIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1759
Mailing Address - Country:US
Mailing Address - Phone:856-455-7017
Mailing Address - Fax:856-455-2594
Practice Address - Street 1:20 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1759
Practice Address - Country:US
Practice Address - Phone:856-455-7017
Practice Address - Fax:856-455-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02579000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058874Medicare ID - Type UnspecifiedGROUP ID