MEDICARE: ESSEX WOMENS HEALTH CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1447380134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSEX WOMENS HEALTH CENTER, PA

Provider Business Mailing Address
First Line	:	33 N FULLERTON AVE
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3412
Country	:	US
Telephone Number	:	973-744-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 N FULLERTON AVE
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3412
Country	:	US
Telephone Number	:	973-744-2922
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY DEGRANDE
Credential	:	MD
Telephone Number	:	201-744-2922

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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