Healthcare Provider Details

I. General information

NPI: 1982803177
Provider Name (Legal Business Name): EAST COAST WOMAN'S HEALTH & PELVIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W BAY AVE SUITE F
BARNEGAT NJ
08005-2150
US

IV. Provider business mailing address

1 ANISE CT
MANAHAWKIN NJ
08050-5610
US

V. Phone/Fax

Practice location:
  • Phone: 609-698-8880
  • Fax: 609-698-8881
Mailing address:
  • Phone: 609-661-4071
  • Fax: 609-978-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MB07112600
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH MICHAEL MILLER
Title or Position: OWNER
Credential: DO
Phone: 609-661-4071