MEDICARE: SPECIALIZING IN WOMEN'S CARE LLC

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	174400000X	Specialist	MA070577	NJ

General Provider Information

NPI Number	:	1609101062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZING IN WOMEN'S CARE LLC

Provider Business Mailing Address
First Line	:	22 SYLVAN ST
Second Line	:	SUITE 300
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2087
Country	:	US
Telephone Number	:	201-438-8860
Fax Number	:	201-438-1994

Provider Business Practice Location Address
First Line	:	22 SYLVAN ST
Second Line	:	SUITE 300
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2087
Country	:	US
Telephone Number	:	201-438-8860
Fax Number	:	201-438-1994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CONSETTA M CHEATAM
Credential	:	M.D.
Telephone Number	:	201-438-8860

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	01/30/2014

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