Provider Demographics
NPI:1902851314
Name:REGIONAL WOMENS HEALTH GROUP LLC
Entity Type:Organization
Organization Name:REGIONAL WOMENS HEALTH GROUP LLC
Other - Org Name:SOUTH JERSEY FERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-6050
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0536
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-651-0794
Practice Address - Street 1:400 LIPPINCOTT DR
Practice Address - Street 2:SUITE 130
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4161
Practice Address - Country:US
Practice Address - Phone:856-596-2233
Practice Address - Fax:856-596-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:2007-01-05
Deactivation Code:
Reactivation Date:2007-03-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038816Medicare ID - Type Unspecified