MEDICARE: CHOICE GYNECOLOGICAL SERVICES, 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	207VG0400X	Gynecology Physician	092267	NY

General Provider Information

NPI Number	:	1275775595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE GYNECOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	8926 ROOSEVELT AVE
Second Line	:	2ND FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-205-3400
Fax Number	:	718-205-6100

Provider Business Practice Location Address
First Line	:	8926 ROOSEVELT AVE
Second Line	:	2ND FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-205-3400
Fax Number	:	718-205-6100

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOEL COOPER
Credential	:	M.D.
Telephone Number	:	718-205-3400

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/02/2009

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