Healthcare Provider Details

I. General information

NPI: 1184873572
Provider Name (Legal Business Name): WOMENS MEDICAL SERVICES OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 FLATLANDS AVE SUITE 206
BROOKLYN NY
11236-3726
US

IV. Provider business mailing address

2 BARNES LN
GARDEN CITY NY
11530-4402
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2420
  • Fax:
Mailing address:
  • Phone: 718-485-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number60 66418
License Number StateNY

VIII. Authorized Official

Name: JUAN SANDOVAL
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-485-2420