Healthcare Provider Details

I. General information

NPI: 1336716059
Provider Name (Legal Business Name): MATERNITY MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 12TH ST
NEW YORK NY
10011-8142
US

IV. Provider business mailing address

1225 PARK AVE # 1D
NEW YORK NY
10128-1758
US

V. Phone/Fax

Practice location:
  • Phone: 212-705-8785
  • Fax: 212-370-4390
Mailing address:
  • Phone: 212-741-2229
  • Fax: 212-741-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: JAQUELINE M WORTH
Title or Position: MANAGER
Credential: MD
Phone: 212-741-2229