=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861522781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMAN TO WOMAN OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 07/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 W MAIN ST STE. 240/2ND FLOOR
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-308-2255
-----------------------------------------------------
Fax | 732-308-0081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 W MAIN ST STE. 240/2ND FLOOR
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-308-2255
-----------------------------------------------------
Fax | 732-308-0081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CASANDRA HICKS AUTRY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-308-2255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------