Healthcare Provider Details

I. General information

NPI: 1225495427
Provider Name (Legal Business Name): VILLAGE MATERNITY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 12/18/2022
Certification Date: 12/18/2022
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 STE 1D
NEW YORK NY
10128-1758
US

V. Phone/Fax

Practice location:
  • Phone: 212-705-8785
  • Fax: 877-370-4390
Mailing address:
  • Phone: 212-741-2229
  • Fax: 212-741-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number211448
License Number StateNY
# 4
Primary TaxonomyY
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