Healthcare Provider Details

I. General information

NPI: 1275855900
Provider Name (Legal Business Name): VILLAGE OBSTETRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 PARK AVE STE 1D
NEW YORK NY
10128-1758
US

IV. Provider business mailing address

1225 PARK AVE STE 1D
NEW YORK NY
10128-1758
US

V. Phone/Fax

Practice location:
  • Phone: 212-741-2229
  • Fax: 212-741-2228
Mailing address:
  • Phone: 212-741-2228
  • Fax: 212-741-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2114481
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number198008-1
License Number StateNY

VIII. Authorized Official

Name: JAQUELINE M WORTH
Title or Position: MANAGER
Credential: MD
Phone: 212-741-2229