Healthcare Provider Details

I. General information

NPI: 1760706931
Provider Name (Legal Business Name): REPRODUCTIVE SPECIALISTS OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OLD COUNTRY RD SUITE 325
MINEOLA NY
11501-4235
US

IV. Provider business mailing address

200 OLD COUNTRY RD SUITE 325
MINEOLA NY
11501-4235
US

V. Phone/Fax

Practice location:
  • Phone: 516-739-2100
  • Fax:
Mailing address:
  • Phone: 516-739-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN INGRAM
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 516-739-2100