Provider Demographics
NPI:1477507309
Name:WOMEN'S HEALTH ASSOCIATES OF SOMERSET, P.A.
Entity type:Organization
Organization Name:WOMEN'S HEALTH ASSOCIATES OF SOMERSET, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:KICENUIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-873-4200
Mailing Address - Street 1:51 GEIGER LANE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5641
Mailing Address - Country:US
Mailing Address - Phone:732-873-4200
Mailing Address - Fax:732-873-4201
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-563-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03343200207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty