Healthcare Provider Details

I. General information

NPI: 1295249100
Provider Name (Legal Business Name): RIDGEWOODS OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 FRESH POND RD
RIDGEWOOD NY
11385-3334
US

IV. Provider business mailing address

6605 FRESH POND RD
RIDGEWOOD NY
11385-3334
US

V. Phone/Fax

Practice location:
  • Phone: 917-513-1374
  • Fax:
Mailing address:
  • Phone: 917-513-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number264565
License Number StateNY

VIII. Authorized Official

Name: DR. OSKAR A GAWEDA
Title or Position: PROVIDER
Credential: MD
Phone: 917-513-1374