Provider Demographics
NPI:1578349122
Name:NORTHEAST WOMEN HEALTH PC
Entity type:Organization
Organization Name:NORTHEAST WOMEN HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOROZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-597-4000
Mailing Address - Street 1:505 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4027
Mailing Address - Country:US
Mailing Address - Phone:201-597-4000
Mailing Address - Fax:
Practice Address - Street 1:695 N RTE 17 STE 101
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3110
Practice Address - Country:US
Practice Address - Phone:201-597-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care