Healthcare Provider Details

I. General information

NPI: 1093807778
Provider Name (Legal Business Name): WOMENS HEALTHCARE & AESTHETICS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEW HAMPSHIRE AVE
LAKEWOOD NJ
08701-4509
US

IV. Provider business mailing address

400 NEW HAMPSHIRE AVE
LAKEWOOD NJ
08701-4509
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-1290
  • Fax: 732-905-8649
Mailing address:
  • Phone: 732-364-1290
  • Fax: 732-905-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA065067
License Number StateNJ

VIII. Authorized Official

Name: NILES EDWARD CHOPER
Title or Position: OWNER
Credential: MD
Phone: 732-364-1290