Provider Demographics
NPI:1356586671
Name:JERSEY SHORE WOMEN'S HEALTH, LLC
Entity type:Organization
Organization Name:JERSEY SHORE WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-359-7060
Mailing Address - Street 1:1930 HWY 35 STE 3
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3538
Mailing Address - Country:US
Mailing Address - Phone:732-359-7060
Mailing Address - Fax:
Practice Address - Street 1:1930 HWY 35 STE 3
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3538
Practice Address - Country:US
Practice Address - Phone:732-359-7060
Practice Address - Fax:732-359-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty