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General NPI Number Information
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NPI Number | 1255023628
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Entity Type | Organization
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Legal Business Name | INTEGRATED REPRODUCTIVE SURGERY LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 779 NORTH ST
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City | GREENWICH
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State | CT
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Zip | 06831-3105
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Country | US
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Telephone | 646-844-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 204 CORLIES AVE
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City | PELHAM
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State | NY
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Zip | 10803-1904
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Country | US
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Telephone | 646-844-9602
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. BRANDON PROVOST
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Credential |
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Telephone | 832-515-6129
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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 |
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License Number State |
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