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General NPI Number Information
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NPI Number | 1215960679
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Entity Type | Organization
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Legal Business Name | PAVILION WOMENS HEALTH ASSOCIATES PA
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1100 ROUTE 72 W SUITE 305
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2468
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Country | US
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Telephone | 609-978-9841
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Fax | 609-978-9843
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Provider Business Mailing Address
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Address Line | 1100 ROUTE 72 W SUITE 305
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2468
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Country | US
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Telephone | 609-978-9841
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Fax | 609-978-9843
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD J NIEWIADOMSKI
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Credential | M.D.
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Telephone | 609-978-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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