Basic Information
| Provider Information | |||||||||
| NPI: | 1962677195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR WOMEN'S REPRODUCTIVE CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 W 168TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123054098 | ||||||||
| FaxNumber: | 2123052229 | ||||||||
| Practice Location | |||||||||
| Address1: | 1790 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100191412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467568282 | ||||||||
| FaxNumber: | 2123052229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | D'ALTON | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPARTMNET CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 2123052377 | ||||||||
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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 | 207VE0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
No ID Information.