Healthcare Provider Details

I. General information

NPI: 1366742009
Provider Name (Legal Business Name): NEW YORK CITY IN VITRO FERTILIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 56TH ST SUITE 1
NEW YORK NY
10022-4147
US

IV. Provider business mailing address

PO BOX 6755
NEW YORK NY
10150-6755
US

V. Phone/Fax

Practice location:
  • Phone: 800-853-7595
  • Fax:
Mailing address:
  • Phone: 973-773-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PEYMAN MAGHSOUDLOU
Title or Position: MANAGER
Credential:
Phone: 973-773-2039