Healthcare Provider Details

I. General information

NPI: 1053509992
Provider Name (Legal Business Name): NORTH VILLAGE OB/GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HEMPSTEAD TPKE 2ND FLOOR
FRANKLIN SQUARE NY
11010-3641
US

IV. Provider business mailing address

925 HEMPSTEAD TPKE 2ND FLOOR
FRANKLIN SQUARE NY
11010-3641
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-7100
  • Fax:
Mailing address:
  • Phone: 516-354-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number197740
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number156347
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID J WOLFSON
Title or Position: PRESIDENT
Credential:
Phone: 516-354-7100