MEDICARE: COMPASSIONATE OFFICE GYNECOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073540803	OTHER	NY	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1124260617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE OFFICE GYNECOLOGY PC

Provider Business Mailing Address
First Line	:	129 CLOVE BRANCH RD
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-5284
Country	:	US
Telephone Number	:	845-592-4036
Fax Number	:	845-592-4038

Provider Business Practice Location Address
First Line	:	129 CLOVE BRANCH RD
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-5284
Country	:	US
Telephone Number	:	845-592-4036
Fax Number	:	845-592-4038

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BARBARA WHITE
Credential	:	DO
Telephone Number	:	845-592-4036

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	10/24/2014

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