Provider Demographics
NPI:1902964364
Name:WOMENS HEALTH ALLIANCE LLC
Entity Type:Organization
Organization Name:WOMENS HEALTH ALLIANCE LLC
Other - Org Name:WOMENS HEALTH ALLIANCE OF NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABORTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-935-0700
Mailing Address - Street 1:142 HIGHWAY 35
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:732-935-0700
Mailing Address - Fax:732-935-0731
Practice Address - Street 1:142 HWY 35
Practice Address - Street 2:STE 105
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3427
Practice Address - Country:US
Practice Address - Phone:732-935-0700
Practice Address - Fax:732-935-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004189Medicaid
NJ071478Medicare ID - Type UnspecifiedGROUP MEDICARE #