Healthcare Provider Details

I. General information

NPI: 1275571242
Provider Name (Legal Business Name): PROSPECT WOMEN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROSPECT AVE
HACKENSACK NJ
07601-2256
US

IV. Provider business mailing address

120 PROSPECT AVE
HACKENSACK NJ
07601-2256
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1600
  • Fax:
Mailing address:
  • Phone: 201-342-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA02186100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier490858
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGROUP AETNA #
# 2
IdentifierCB7339
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGROUP RAILROAD MEDICARE #

VIII. Authorized Official

Name: DR. CHARLES STRANIERO
Title or Position: PARTNER
Credential: MD
Phone: 201-342-1600