1578752085 NPI number — NEW WINDSOR GYNECOLOGY, PC

Table of content: (NPI 1578752085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578752085 NPI number — NEW WINDSOR GYNECOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW WINDSOR GYNECOLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578752085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 HUDSON VALLEY AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NEW WINDSOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12553-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-567-3420
Provider Business Mailing Address Fax Number:
845-567-3421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 HUDSON VALLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-567-3420
Provider Business Practice Location Address Fax Number:
845-567-3421
Provider Enumeration Date:
10/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZESZUTEK
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-567-3420

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  233468 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02600737 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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