Healthcare Provider Details

I. General information

NPI: 1093423378
Provider Name (Legal Business Name): WOMEN'S HEALTH MEDICAL GROUP OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEDICAL PARK DR STE 100
POMONA NY
10970-3559
US

IV. Provider business mailing address

PO BOX 22573
NEW YORK NY
10087-2573
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-0003
  • Fax:
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-528-3117

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: ELIZABETH CHEROT
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 856-669-6050