=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659823680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERTILITY LAB SCIENCES OF NEW YORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2016
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 SEVENTH AVENUE FLOOR 21
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-290-8100
-----------------------------------------------------
Fax | 212-239-6500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 SEVENTH AVENUE FLOOR 21
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-290-8100
-----------------------------------------------------
Fax | 212-239-6500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | JANET CHOI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-290-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0006X
-----------------------------------------------------
Taxonomy Name | Ambulatory Fertility Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------