Healthcare Provider Details

I. General information

NPI: 1790741700
Provider Name (Legal Business Name): JANE WEBER OWEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE WEBER

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-4670
  • Fax:
Mailing address:
  • Phone: 718-405-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number232101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: