Healthcare Provider Details

I. General information

NPI: 1073776266
Provider Name (Legal Business Name): KIPS BAY GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 32ND ST SUITE 101
NEW YORK NY
10016-6024
US

IV. Provider business mailing address

150 EAST 32ND STREET SUITE 101
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-6792
  • Fax: 212-889-7089
Mailing address:
  • Phone: 212-686-6792
  • Fax: 212-889-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number185602
License Number StateNY

VIII. Authorized Official

Name: ILENE MAE FISCHER
Title or Position: OWNER
Credential: MD
Phone: 212-686-6792