Organization
NORTHEAST WOMEN'S CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN MARIE VAIL (NETWORK BILLING COORDINATOR)
(856) 414-1120
Entity
Organization
Contact information
Practice address
2751 COMLY RD, PHILADELPHIA, PA 19154-2101
(800) 877-6336
Mailing address
500 KINGS HWY N, SUITE 300, CHERRY HILL, NJ 08034-1502
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053004000
INDEPENDENT BLUE CROSS
—
01
—
30018608
KEYSTONE MERCY
—
Enumeration date
05/19/2006
Last updated
08/22/2020
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