Healthcare Provider Details

I. General information

NPI: 1275831364
Provider Name (Legal Business Name): WOMEN'S HEALTH COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 BROAD ST
CLIFTON NJ
07013-1645
US

IV. Provider business mailing address

716 BROAD ST
CLIFTON NJ
07013-1645
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-2912
  • Fax: 973-928-2915
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00049201
License Number StateNJ

VIII. Authorized Official

Name: LONNIE MORRIS
Title or Position: DIRECTOR
Credential: CNM, ND
Phone: 973-928-2912