Healthcare Provider Details

I. General information

NPI: 1740208305
Provider Name (Legal Business Name): STATEN ISLAND UNIVERSITY HOSPITAL PERINATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SEAVIEW AVE
STATEN ISLAND NY
10305-3401
US

IV. Provider business mailing address

1 EDGEWATER STREET SUITE 723
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8662
  • Fax:
Mailing address:
  • Phone: 718-226-1013
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES DUCEY
Title or Position: DIRECTOR
Credential:
Phone: 718-226-8662