Provider Demographics
NPI:1851338297
Name:FIRST STATE WOMEN'S CARE, P.A.
Entity Type:Organization
Organization Name:FIRST STATE WOMEN'S CARE, P.A.
Other - Org Name:OSTRUM & WISNIEWSKI MD'S, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-454-9800
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-454-9800
Mailing Address - Fax:302-454-6446
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-454-9800
Practice Address - Fax:302-454-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE304495OtherCOVENTRY
0794507000OtherAMERIHEALTH
55324OtherAETNA
55324OtherAETNA
0055325Medicare ID - Type UnspecifiedRAILROAD MEDICARE
DE304495OtherCOVENTRY
0794507000OtherAMERIHEALTH