1457451601 NPI number — WOMENS ROOM OBGYN PLLC

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 1457451601 NPI number — WOMENS ROOM OBGYN PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS ROOM OBGYN PLLC
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:
1457451601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 FACTORY ST
Provider Second Line Business Mailing Address:
PO BOX 91
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13601-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-782-4207
Provider Business Mailing Address Fax Number:
315-782-8699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 OUTER MAIN ST
Provider Second Line Business Practice Location Address:
NATCO BUILDING
Provider Business Practice Location Address City Name:
POTSDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13676-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-265-2153
Provider Business Practice Location Address Fax Number:
315-265-2540
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
315-265-2153

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  156476 , 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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