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General NPI Number Information
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NPI Number | 1033365259
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Entity Type | Organization
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Legal Business Name | MICHAEL D VARDY GYNECOLOGY AND UROGYNECOLOGY, LLC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 1107 5TH AVE STE 1E
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City | NEW YORK
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State | NY
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Zip | 10128-0145
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Country | US
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Telephone | 646-345-5249
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Fax |
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Provider Business Mailing Address
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Address Line | 7 PARK ST APT 8P
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City | TENAFLY
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State | NJ
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Zip | 07670-2217
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Country | US
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Telephone | 646-345-5249
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL D VARDY
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Credential | MD
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Telephone | 646-345-5249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 1928071
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License Number State | NY
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