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General NPI Number Information
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NPI Number | 1184808990
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Entity Type | Organization
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Legal Business Name | CONTEMPORARY OB GYN PHYSICIAN SPECIALISTS PC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 3001 EXPRESSWAY DR N SUITE 116
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City | ISLANDIA
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State | NY
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Zip | 11749-5301
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Country | US
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Telephone | 631-292-6747
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Fax | 631-292-6767
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Provider Business Mailing Address
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Address Line | 3001 EXPRESSWAY DR N SUITE 116
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City | ISLANDIA
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State | NY
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Zip | 11749-5301
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Country | US
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Telephone | 631-292-6747
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Fax | 631-292-6767
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN P MCKENNA
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Credential | MD
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Telephone | 631-292-6747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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