Healthcare Provider Details

I. General information

NPI: 1710156617
Provider Name (Legal Business Name): LAFEMME MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24111 147TH AVE
ROSEDALE NY
11422-2455
US

IV. Provider business mailing address

24111 147TH AVE
ROSEDALE NY
11422-2455
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-8667
  • Fax: 718-276-3685
Mailing address:
  • Phone: 718-978-8667
  • Fax: 718-276-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number205649
License Number StateNY

VIII. Authorized Official

Name: GODWIN ONYEIKE
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 718-978-8667