Healthcare Provider Details

I. General information

NPI: 1952674129
Provider Name (Legal Business Name): NEW TOWN OBSTETRICS & GYNECOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GRANT ST STE 207
GARY IN
46404-3439
US

IV. Provider business mailing address

2200 GRANT ST STE 207
GARY IN
46404-3439
US

V. Phone/Fax

Practice location:
  • Phone: 219-944-7565
  • Fax:
Mailing address:
  • Phone: 219-944-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY O IWUAGWU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-944-7565