Provider Demographics
NPI:1295748168
Name:NORTHERN BAY WOMENS HEALTH CENTER, PA
Entity type:Organization
Organization Name:NORTHERN BAY WOMENS HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-574-0111
Mailing Address - Street 1:6100 WINDCOM COURT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7888
Mailing Address - Country:US
Mailing Address - Phone:469-574-0111
Mailing Address - Fax:469-574-0099
Practice Address - Street 1:6100 WINDCOM COURT
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7888
Practice Address - Country:US
Practice Address - Phone:459-574-0111
Practice Address - Fax:469-574-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0808512901Medicaid
TX0808512901Medicaid
TXF13312Medicare UPIN