=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104945666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL WOMEN'S MEDICAL PAVILION P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6930 AUSTIN ST
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-4222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-793-1943
-----------------------------------------------------
Fax | 718-793-1409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6930 AUSTIN ST
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-4222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-793-1943
-----------------------------------------------------
Fax | 718-793-1409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | STEPHANIE GUILBAUD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-793-1943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------