=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699934653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST COAST FERTILITY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 06/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 MONTAUK HWY SUITE A
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795-4418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-661-5437
-----------------------------------------------------
Fax | 631-661-5436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 MONTAUK HWY SUITE A
-----------------------------------------------------
City | WEST ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11795-4418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-661-5437
-----------------------------------------------------
Fax | 631-661-5436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING ADMIN
-----------------------------------------------------
Name | DONNA GERACI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-605-1060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------