1851690788 NPI number — LONG ISLAND WOMEN'S OBSTETRICS AND GYNECOLOGY PLLC

Table of content: (NPI 1851690788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851690788 NPI number — LONG ISLAND WOMEN'S OBSTETRICS AND GYNECOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND WOMEN'S OBSTETRICS AND GYNECOLOGY 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:
6
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:
1851690788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 NEW HYDE PARK RD
Provider Second Line Business Mailing Address:
SUITE 407
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-488-8145
Provider Business Mailing Address Fax Number:
516-488-6722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 NEW HYDE PARK RD
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-488-8145
Provider Business Practice Location Address Fax Number:
516-488-6722
Provider Enumeration Date:
03/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JACOB
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSCIAN/OWNER SOLO LLC PRACTICE
Authorized Official Telephone Number:
516-488-8145

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  161044 , 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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