1851527972 NPI number — WASHINGTON PARK WOMEN'S HEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851527972 NPI number — WASHINGTON PARK WOMEN'S HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON PARK WOMEN'S HEALTH 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:
1851527972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 ROUTE 112
Provider Second Line Business Mailing Address:
BLDG 11 SUITE A
Provider Business Mailing Address City Name:
PORT JEFFERSON STATION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11776-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-331-1120
Provider Business Mailing Address Fax Number:
631-331-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 ROUTE 112
Provider Second Line Business Practice Location Address:
BLDG 11 SUITE A
Provider Business Practice Location Address City Name:
PORT JEFFERSON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11776-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-331-1120
Provider Business Practice Location Address Fax Number:
631-331-1048
Provider Enumeration Date:
06/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TUFANO
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
HOPE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
631-331-1120

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  228608 , 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)





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