Healthcare Provider Details

I. General information

NPI: 1801077193
Provider Name (Legal Business Name): LONG ISLAND WOMEN'S HEALTH CARE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MINEOLA BLVD SUITE 200-202
MINEOLA NY
11501-2528
US

IV. Provider business mailing address

173 MINEOLA BLVD SUITE 200-202
MINEOLA NY
11501-2528
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-4321
  • Fax: 516-535-1332
Mailing address:
  • Phone: 516-741-4321
  • Fax: 516-535-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1248511
License Number StateNY

VIII. Authorized Official

Name: DR. GARY MORTON LEVINE
Title or Position: PRESIDENT
Credential: MD
Phone: 516-741-4321