Healthcare Provider Details

I. General information

NPI: 1164979092
Provider Name (Legal Business Name): URGYN WOMEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVER AVE SUITE 255
LAKEWOOD NJ
08701-4738
US

IV. Provider business mailing address

615 FRANKLIN TPKE
RIDGEWOOD NJ
07450-1903
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-1700
  • Fax: 201-447-9386
Mailing address:
  • Phone: 201-447-1700
  • Fax: 201-447-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SUSAN BOUSKILA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 718-253-8111