Healthcare Provider Details

I. General information

NPI: 1831278282
Provider Name (Legal Business Name): WOMEN AND CHILDREN PRIMARY CARE OF PASSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PASSAIC AVE
PASSAIC NJ
07055-4801
US

IV. Provider business mailing address

61 PASSAIC AVE
PASSAIC NJ
07055-4801
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-5053
  • Fax: 973-574-9430
Mailing address:
  • Phone: 973-473-5053
  • Fax: 973-574-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARILYN CRESPO
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-473-5053