MEDICARE: STATEN ISLAND REPRODUCTIVE MEDICINE PLLC

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	207VE0102X	Reproductive Endocrinology Physician

General Provider Information

NPI Number	:	1821742487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN ISLAND REPRODUCTIVE MEDICINE PLLC

Provider Business Mailing Address
First Line	:	94 OLD SHORT HILLS RD STE 403
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5672
Country	:	US
Telephone Number	:	973-548-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 SOUTH AVE # 201
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3425
Country	:	US
Telephone Number	:	973-548-0900
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	LISA MILLER
Credential	:
Telephone Number	:	732-317-8286

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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