Healthcare Provider Details

I. General information

NPI: 1467560938
Provider Name (Legal Business Name): BERGEN-PASSAIC WOMENS HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 GODWIN AVE
WYCKOFF NJ
07481
US

IV. Provider business mailing address

258 GODWIN AVE
WYCKOFF NJ
07481
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-3336
  • Fax: 201-891-0627
Mailing address:
  • Phone: 201-891-3336
  • Fax: 201-891-0627

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: DR. JOSEPH GARTNER
Title or Position: OWNER
Credential: MD
Phone: 201-891-3336