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General NPI Number Information
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NPI Number | 1396764528
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Entity Type | Organization
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Legal Business Name | NORTHEAST CENTER FOR WOMEN'S HEALTH, INC.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 11135 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45249-2338
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Country | US
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Telephone | 513-793-2220
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Fax | 513-793-5933
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Provider Business Mailing Address
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Address Line | 11135 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45249-2338
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Country | US
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Telephone | 513-793-2220
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Fax | 513-793-5933
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JON RICHARD FACKLER
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Credential | MD
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Telephone | 513-793-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | OH
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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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