Provider Demographics
NPI:1831278282
Name:WOMEN AND CHILDREN PRIMARY CARE OF PASSAIC
Entity type:Organization
Organization Name:WOMEN AND CHILDREN PRIMARY CARE OF PASSAIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-473-5053
Mailing Address - Street 1:61 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4801
Mailing Address - Country:US
Mailing Address - Phone:973-473-5053
Mailing Address - Fax:973-574-9430
Practice Address - Street 1:61 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4801
Practice Address - Country:US
Practice Address - Phone:973-473-5053
Practice Address - Fax:973-574-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5337101Medicaid
NJ5337101Medicaid
F74940Medicare PIN