Healthcare Provider Details

I. General information

NPI: 1164605531
Provider Name (Legal Business Name): MARTINSVILLE WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 12/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 CHIMNEY ROCK RD SUITE G
MARTINSVILLE NJ
08836-2272
US

IV. Provider business mailing address

784 CHIMNEY ROCK RD SUITE G
MARTINSVILLE NJ
08836-2272
US

V. Phone/Fax

Practice location:
  • Phone: 732-271-1771
  • Fax: 732-271-9477
Mailing address:
  • Phone: 732-271-1771
  • Fax: 732-271-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA05501700
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH ROBERT IVAN
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 732-271-1771