MEDICARE: WOMEN'S CARE PHYSICIANS GROUP 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		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1150683	OTHER	NJ	HORIZON MERCY
2	2073315000	OTHER	NJ	AMERIHEALTH
3	7756317	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1891963658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S CARE PHYSICIANS GROUP LLC

Provider Business Mailing Address
First Line	:	225 WILLIAMSON ST
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-3625
Country	:	US
Telephone Number	:	908-994-5197
Fax Number	:	908-994-5742

Provider Business Practice Location Address
First Line	:	65 JEFFERSON AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07201-2474
Country	:	US
Telephone Number	:	908-994-5500
Fax Number	:	908-558-0190

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LANETTE LABOY
Credential	:
Telephone Number	:	908-994-5197

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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