Basic Information
| Provider Information | |||||||||
| NPI: | 1053454702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST VINCENTS CATHOLIC MEDICAL CENTER OB-GYN DEPT | ||||||||
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| OtherOrganizationName: | SVCMC OB-GYN DEPT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 W 33RD ST | ||||||||
| Address2: | 12TH FL PBS DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564458 | ||||||||
| FaxNumber: | 2123564608 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100118202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564458 | ||||||||
| FaxNumber: | 2123564608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 10/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | REN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2123564458 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.