=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124334552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWOOD OBSTETRICS AND GYNECOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2010
-----------------------------------------------------
Last Update Date | 09/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 AVENUE J
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-677-1710
-----------------------------------------------------
Fax | 718-677-6586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 EASTWOOD RD
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11598-1636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-677-1710
-----------------------------------------------------
Fax | 718-677-6586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATING AGENT
-----------------------------------------------------
Name | DR. AARON WEINREB
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-677-1710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------