Healthcare Provider Details

I. General information

NPI: 1609101062
Provider Name (Legal Business Name): SPECIALIZING IN WOMEN'S CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SYLVAN ST SUITE 300
RUTHERFORD NJ
07070-2087
US

IV. Provider business mailing address

22 SYLVAN ST SUITE 300
RUTHERFORD NJ
07070-2087
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-8860
  • Fax: 201-438-1994
Mailing address:
  • Phone: 201-438-8860
  • Fax: 201-438-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA070577
License Number StateNJ

VIII. Authorized Official

Name: DR. CONSETTA M CHEATAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-438-8860