Healthcare Provider Details

I. General information

NPI: 1083984496
Provider Name (Legal Business Name): GATEWAY OB/GYN ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CROMWELL AVENUE
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

78 CROMWELL AVENUE
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-9175
  • Fax: 718-987-1678
Mailing address:
  • Phone: 718-987-9175
  • Fax: 718-987-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN LEO PRUE
Title or Position: VICE PRES. / SECRETARY
Credential: M.D.
Phone: 718-987-9175