Provider Demographics
NPI:1285706705
Name:FAIR LAWN WOMENS HEALTH
Entity type:Organization
Organization Name:FAIR LAWN WOMENS HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD TD
Authorized Official - Phone:201-796-2025
Mailing Address - Street 1:5-22 SADDLE RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5611
Mailing Address - Country:US
Mailing Address - Phone:201-796-2025
Mailing Address - Fax:201-796-0587
Practice Address - Street 1:5-22 SADDLE RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5611
Practice Address - Country:US
Practice Address - Phone:201-796-2025
Practice Address - Fax:201-796-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526218Medicare PIN