Healthcare Provider Details

I. General information

NPI: 1710923123
Provider Name (Legal Business Name): WOMENS HEALTHCARE OF SOUTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAGNOLIA AVE SUITE A
BRIDGETON NJ
08302-1759
US

IV. Provider business mailing address

20 MAGNOLIA AVE SUITE A
BRIDGETON NJ
08302-1759
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-7017
  • Fax: 856-455-2594
Mailing address:
  • Phone: 856-455-7017
  • Fax: 856-455-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA02579000
License Number StateNJ

VIII. Authorized Official

Name: DR. EDWARD S MILNER JR.
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 856-455-7017