Healthcare Provider Details

I. General information

NPI: 1720174972
Provider Name (Legal Business Name): WOMENS HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 FIFTH AVENUE
NEW YORK NY
10021
US

IV. Provider business mailing address

936 FIFTH AVENUE
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-1893
  • Fax: 212-861-8725
Mailing address:
  • Phone: 212-734-1893
  • Fax: 212-861-8725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number184651
License Number StateNY

VIII. Authorized Official

Name: DR. MARY LEE RIVER CASAMENTO
Title or Position: PRESIDENT
Credential: MD
Phone: 212-734-1893