Healthcare Provider Details

I. General information

NPI: 1649399486
Provider Name (Legal Business Name): WOMENS HEALTH PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SALEM WOODSTOWN ROAD SUITE#6
SALEM NJ
08079
US

IV. Provider business mailing address

330 SALEM WOODSTOWN ROAD SUITE#6
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-1900
  • Fax: 856-935-1924
Mailing address:
  • Phone: 856-935-1900
  • Fax: 856-935-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number25ME00026801
License Number StateNJ

VIII. Authorized Official

Name: MRS. LUCINDA G. SHAW
Title or Position: OWNER
Credential: CNM MSN
Phone: 856-935-1900