Basic Information
| Provider Information | |||||||||
| NPI: | 1386776474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE WOMAN'SHEALTHCARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 EISENHOWER PKWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070391792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737169600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 316 EISENHOWER PKWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070391792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737169600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROWE | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AGENT | ||||||||
| AuthorizedOfficialTelephone: | 7322746700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MA015819 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.