Provider Demographics
NPI:1790720449
Name:WOMEN'S HEALTH CARE GROUP PC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CARE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATTAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-907-0900
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-907-0900
Mailing Address - Fax:
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-907-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03819000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0049262OtherAETNA HMO GROUP #
NJ6982409Medicaid
NJ0142333000OtherAMERIHEALTH GROUP #
NJC12983OtherRAILROAD MEDICARE GROUP #
NJ5771292OtherAETNA PPO GROUP #
NJ885925Medicare PIN