Provider Demographics
NPI:1245084250
Name:ELECTRA WOMENS HEALTH MEDICAL INC
Entity type:Organization
Organization Name:ELECTRA WOMENS HEALTH MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-760-6669
Mailing Address - Street 1:228 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:202-524-8706
Mailing Address - Fax:
Practice Address - Street 1:2009 MACKENZIE WAY
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5338
Practice Address - Country:US
Practice Address - Phone:646-760-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty