Healthcare Provider Details

I. General information

NPI: 1831219724
Provider Name (Legal Business Name): STONE GATE OB GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16303 HORACE HARDING EXPY STE 300
FRESH MEADOWS NY
11365-1449
US

IV. Provider business mailing address

16303 HORACE HARDING EXPY STE 300
FRESH MEADOWS NY
11365-1449
US

V. Phone/Fax

Practice location:
  • Phone: 866-880-0800
  • Fax:
Mailing address:
  • Phone: 866-880-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number197255
License Number StateNY

VIII. Authorized Official

Name: DR. SUZZETTE N ROBINSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 866-880-0800