=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720174972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 12/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 936 FIFTH AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-734-1893
-----------------------------------------------------
Fax | 212-861-8725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 936 FIFTH AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-734-1893
-----------------------------------------------------
Fax | 212-861-8725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARY LEE RIVER CASAMENTO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-734-1893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 184651
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------