Healthcare Provider Details

I. General information

NPI: 1932334315
Provider Name (Legal Business Name): COMPLETE WOMAN MIDWIFERY & COMPLETE MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LINCOLN TER
CALDWELL NJ
07006-5611
US

IV. Provider business mailing address

2 LINCOLN TER
CALDWELL NJ
07006-5611
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-2563
  • Fax:
Mailing address:
  • Phone: 973-226-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25MW00000100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25MM00000700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF0011431
License Number StateNY

VIII. Authorized Official

Name: MS. LINDA ALICE PERRY
Title or Position: MIDWIFE/OWNER
Credential: CM, CPM
Phone: 973-226-2563