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General NPI Number Information
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NPI Number | 1699165522
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Entity Type | Organization
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Legal Business Name | THE PLACE FOR WOMEN
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 6601 VENTNOR AVENUE
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City | VENTNOR
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State | NJ
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Zip | 08406
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Country | US
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Telephone | 814-558-7303
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 676
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City | DOWNINGTOWN
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State | PA
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Zip | 19335
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Country | US
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Telephone | 814-558-7303
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Fax |
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Authorized Official
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Title or Position | OBETETRICIAN & GYNECOLOGIST
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Name | DR. NWOGO NNUNWA AGBASI
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Credential | MD
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Telephone | 814-558-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA08155300
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License Number State | NJ
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