Provider Demographics
NPI:1386963411
Name:CENTER FOR WOMENS HEALTH LLC
Entity type:Organization
Organization Name:CENTER FOR WOMENS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-858-1585
Mailing Address - Street 1:744 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3948
Mailing Address - Country:US
Mailing Address - Phone:201-858-1585
Mailing Address - Fax:201-858-0467
Practice Address - Street 1:744 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3948
Practice Address - Country:US
Practice Address - Phone:201-858-1585
Practice Address - Fax:201-858-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05208400207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0886700Medicaid
C54264Medicare UPIN