Healthcare Provider Details

I. General information

NPI: 1942770425
Provider Name (Legal Business Name): CENTER FOR INNOVATIVE GYN CARE NE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLAREMONT AVE
MONTCLAIR NJ
07042
US

IV. Provider business mailing address

3206 TOWER OAKS BLVD STE 200
ROCKVILLE MD
20852-4253
US

V. Phone/Fax

Practice location:
  • Phone: 301-603-2622
  • Fax:
Mailing address:
  • Phone: 301-603-2622
  • Fax: 301-664-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS S FINLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-603-2622