Provider Demographics
NPI:1811940760
Name:NORTHEAST WOMEN'S CENTER, INC.
Entity type:Organization
Organization Name:NORTHEAST WOMEN'S CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-414-1120
Mailing Address - Street 1:500 KINGS HWY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2751 COMLY RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2101
Practice Address - Country:US
Practice Address - Phone:800-877-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30018608OtherKEYSTONE MERCY
0053004000OtherINDEPENDENT BLUE CROSS