Provider Demographics
NPI:1760424477
Name:AVALON. A CENTER FOR WOMEN'S HEALTH
Entity Type:Organization
Organization Name:AVALON. A CENTER FOR WOMEN'S HEALTH
Other - Org Name:AVALON WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNM/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOSA
Authorized Official - Suffix:
Authorized Official - Credentials:CNM MS
Authorized Official - Phone:973-998-7922
Mailing Address - Street 1:25 LINDSLEY DRIVE SUITE 201A
Mailing Address - Street 2:AVALON. A CENTER FOR WOMAN'S HEALTH
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4456
Mailing Address - Country:US
Mailing Address - Phone:973-998-7922
Mailing Address - Fax:973-998-7925
Practice Address - Street 1:25 LINDSLEY DRIVE, SUITE 201A
Practice Address - Street 2:AVALON . A CENTER FOR WOMAN'S HEALTH
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-998-7922
Practice Address - Fax:973-998-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty