Basic Information
Provider Information | |||||||||
NPI: | 1114081601 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WOMEN FIRST HEALTHCARE OF WESTERN NEW YORK PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 240 REDTAIL DR | ||||||||
Address2: | STE 5&6 | ||||||||
City: | ORCHARD PARK | ||||||||
State: | NY | ||||||||
PostalCode: | 141270000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166770454 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 240 REDTAIL DR | ||||||||
Address2: | STE 5&6 | ||||||||
City: | ORCHARD PARK | ||||||||
State: | NY | ||||||||
PostalCode: | 141270000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166770454 | ||||||||
FaxNumber: | 7167120061 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/20/2006 | ||||||||
LastUpdateDate: | 06/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FARKASH | ||||||||
AuthorizedOfficialFirstName: | GIL | ||||||||
AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 7166770454 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 197614 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 0709050 | 01 | NY | INDEPENDENT HEALTH | OTHER | 0298342 | 01 | NY | GHI | OTHER | 01744247 | 05 | NY |   | MEDICAID | UNIVERA | 01 | NY | 00010301707 | OTHER | 0005247179 | 01 | NY | BC BS OF WNY | OTHER | 10172730 | 01 | NY | FIDELIS | OTHER | 1871599381 | 01 | NY | INDIVIDUAL NPI | OTHER |