Basic Information
| Provider Information | |||||||||
| NPI: | 1740208305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STATEN ISLAND UNIVERSITY HOSPITAL PERINATOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 EDGEWATER STREET | ||||||||
| Address2: | SUITE 723 | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182261013 | ||||||||
| FaxNumber: | 7182261039 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 SEAVIEW AVE | ||||||||
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| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103053401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182268662 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUCEY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7182268662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.