Healthcare Provider Details

I. General information

NPI: 1023162385
Provider Name (Legal Business Name): PROSPECT WOMEN'S HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PROSPECT AVE 1B
HACKENSACK NJ
07601-1913
US

IV. Provider business mailing address

77 PROSPECT AVE SUITE#1B
HACKENSACK NJ
07601-1262
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-7002
  • Fax: 201-342-7055
Mailing address:
  • Phone: 201-342-7002
  • Fax: 201-342-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1270009
License Number StateNJ

VIII. Authorized Official

Name: DR. WALEED MOHAMED ABDELGHANI
Title or Position: OFFICER
Credential: M.D.
Phone: 201-342-7002