Healthcare Provider Details

I. General information

NPI: 1376763532
Provider Name (Legal Business Name): FIFTH AVENUE OB GYN ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 5TH AVE
NEW YORK NY
10128-0724
US

IV. Provider business mailing address

1150 5TH AVE
NEW YORK NY
10128-0724
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-9100
  • Fax: 212-996-3870
Mailing address:
  • Phone: 212-996-9100
  • Fax: 212-996-3870

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: PAULA GORDON
Title or Position: MANAGER
Credential:
Phone: 212-996-9100