1962770156 NPI number — GREATER NEW YORK FERTILITY PC

Table of content: (NPI 1962770156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962770156 NPI number — GREATER NEW YORK FERTILITY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER NEW YORK FERTILITY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962770156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
PLANETARIUM STATION
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10024-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-245-5358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 GREENPOINT AVE
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-362-4848
Provider Business Practice Location Address Fax Number:
646-596-8667
Provider Enumeration Date:
12/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDEIS
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
SOLE INCORPORATOR/PRESIDENT
Authorized Official Telephone Number:
646-245-5358

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  162235 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 162235 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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