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General NPI Number Information
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NPI Number | 1366697385
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Entity Type | Organization
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Legal Business Name | REGIONAL GYNECOLOGIC ONCOLOGY
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 2 MEDICAL PARK DR
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City | POMONA
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State | NY
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Zip | 10970-3516
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Country | US
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Telephone | 845-354-6262
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26040
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City | MACON
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State | GA
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Zip | 31221-6040
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Country | US
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Telephone | 478-475-1299
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Fax | 478-405-7928
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Authorized Official
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Title or Position | MD
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Name | EPHRAIM RESNIK
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Credential |
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Telephone | 845-354-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 214871
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License Number State | NY
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