Basic Information
| Provider Information | |||||||||
| NPI: | 1457451601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS ROOM OBGYN PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 FACTORY ST | ||||||||
| Address2: | PO BOX 91 | ||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136012729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157824207 | ||||||||
| FaxNumber: | 3157828699 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 OUTER MAIN ST | ||||||||
| Address2: | NATCO BUILDING | ||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136762324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152652153 | ||||||||
| FaxNumber: | 3152652540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | LYONS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3152652153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 156476 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.