Provider Demographics
NPI:1760719793
Name:PROSPECT WOMEN'S MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:PROSPECT WOMEN'S MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEVAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-1600
Mailing Address - Street 1:120 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2256
Mailing Address - Country:US
Mailing Address - Phone:201-342-1600
Mailing Address - Fax:201-342-2280
Practice Address - Street 1:120 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2256
Practice Address - Country:US
Practice Address - Phone:201-342-1600
Practice Address - Fax:201-342-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05630700207V00000X, 207VX0000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527769Medicare UPIN