Provider Demographics
NPI:1780753442
Name:SPECIALIZED IN WOMENS CARE, LLC
Entity type:Organization
Organization Name:SPECIALIZED IN WOMENS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-438-2824
Mailing Address - Street 1:17 SYLVAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2037
Mailing Address - Country:US
Mailing Address - Phone:201-438-2824
Mailing Address - Fax:201-438-2108
Practice Address - Street 1:17 SYLVAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2037
Practice Address - Country:US
Practice Address - Phone:201-438-2824
Practice Address - Fax:201-438-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID