MEDICARE: GEMINI OB/GYN, P.C.

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	201003	NY

General Provider Information

NPI Number	:	1174853857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEMINI OB/GYN, P.C.

Provider Business Mailing Address
First Line	:	2627 HYLAN BLVD
Second Line	:	SUITE B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4339
Country	:	US
Telephone Number	:	718-980-4009
Fax Number	:	718-987-8516

Provider Business Practice Location Address
First Line	:	2627 HYLAN BLVD
Second Line	:	SUITE B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4339
Country	:	US
Telephone Number	:	718-980-4009
Fax Number	:	718-987-8516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALLEN FUCHS
Credential	:	M.D.
Telephone Number	:	718-980-4009

Provider Enumeration Date	:	01/02/2010
Last Update Date	:	01/02/2010

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