Basic Information
Provider Information | |||||||||
NPI: | 1740506930 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PREMIER WOMEN'S HEALTH OF SOUTH JERSEY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 402 LIPPINCOTT DR | ||||||||
Address2: | ATTN: JWENSAUER | ||||||||
City: | MARLTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 080534112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567823300 | ||||||||
FaxNumber: | 8565048029 | ||||||||
Practice Location | |||||||||
Address1: | 165 PRINCETON AVE | ||||||||
Address2: |   | ||||||||
City: | WOODBURY | ||||||||
State: | NJ | ||||||||
PostalCode: | 080960000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567823300 | ||||||||
FaxNumber: | 8565048029 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/13/2010 | ||||||||
LastUpdateDate: | 04/13/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAPNER | ||||||||
AuthorizedOfficialFirstName: | BYRON | ||||||||
AuthorizedOfficialMiddleName: | SIGFRIED | ||||||||
AuthorizedOfficialTitleorPosition: | SR PARTNER | ||||||||
AuthorizedOfficialTelephone: | 8567823300 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.