MEDICARE: WOMENS HEALTH ALLIANCE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902964364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS HEALTH ALLIANCE LLC

Provider Business Mailing Address
First Line	:	142 HIGHWAY 35
Second Line	:	SUITE 105
City	:	EATONTOWN
State	:	NJ
Zip	:	07724
Country	:	US
Telephone Number	:	732-935-0700
Fax Number	:	732-935-0731

Provider Business Practice Location Address
First Line	:	142 HWY 35
Second Line	:	STE 105
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-3427
Country	:	US
Telephone Number	:	732-935-0700
Fax Number	:	732-935-0731

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. ANU CHAKRABORTY
Credential	:	MD
Telephone Number	:	732-935-0700

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/23/2011

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