Healthcare Provider Details

I. General information

NPI: 1427534783
Provider Name (Legal Business Name): NEW BCGW CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 19TH ST NW STE 150
WASHINGTON DC
20036-6103
US

IV. Provider business mailing address

1020 19TH ST NW STE 150
WASHINGTON DC
20036-6103
US

V. Phone/Fax

Practice location:
  • Phone: 202-293-5182
  • Fax:
Mailing address:
  • Phone: 202-293-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: GINA CARUSO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-293-5182