Healthcare Provider Details

I. General information

NPI: 1811940760
Provider Name (Legal Business Name): NORTHEAST WOMEN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 COMLY RD
PHILADELPHIA PA
19154-2101
US

IV. Provider business mailing address

500 KINGS HWY N SUITE 300
CHERRY HILL NJ
08034-1502
US

V. Phone/Fax

Practice location:
  • Phone: 800-877-6336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MS. KATHLEEN MARIE VAIL
Title or Position: NETWORK BILLING COORDINATOR
Credential:
Phone: 856-414-1120