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General NPI Number Information
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NPI Number | 1508988320
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Entity Type | Organization
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Legal Business Name | NEW LIFE OBGYN GROUP LLP
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 128 MOTT ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10013-5540
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Country | US
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Telephone | 212-219-2723
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Fax | 212-219-2086
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Provider Business Mailing Address
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Address Line | 128 MOTT ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10013-5540
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Country | US
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Telephone | 212-219-2723
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Fax | 212-219-2086
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Authorized Official
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Title or Position | OBSTRETICIANGYNECOLOGIST
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Name | DR. LISA ENG
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Credential | D.O.
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Telephone | 212-219-2723
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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 | 188325
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License Number State | NY
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