Provider Demographics
NPI:1124490487
Name:VERONA WOMEN'S HEALTH
Entity type:Organization
Organization Name:VERONA WOMEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER/CREDENTIALING COORD
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-209-0322
Mailing Address - Street 1:759 BLOOMFIELD AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:799 BLOOMFIELD AVE
Practice Address - Street 2:STE 301
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1367
Practice Address - Country:US
Practice Address - Phone:973-826-4920
Practice Address - Fax:973-826-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09345700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty