Basic Information
| Provider Information | |||||||||
| NPI: | 1043679558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINTHROP COMMUNITY MEDICAL AFFILIATES, PC | ||||||||
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| OtherOrganizationName: | WOMEN'S SPECIALTY CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 HICKSVILLE RD | ||||||||
| Address2: | 204 | ||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165766106 | ||||||||
| FaxNumber: | 5165765801 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 E SUNRISE HWY | ||||||||
| Address2: | 515 | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115811240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167645380 | ||||||||
| FaxNumber: | 5167641915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2016 | ||||||||
| LastUpdateDate: | 02/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | ADLER | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5166633849 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.