=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801077193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG ISLAND WOMEN'S HEALTH CARE GROUP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 05/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 MINEOLA BLVD SUITE 200-202
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-741-4321
-----------------------------------------------------
Fax | 516-535-1332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 MINEOLA BLVD SUITE 200-202
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-741-4321
-----------------------------------------------------
Fax | 516-535-1332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GARY MORTON LEVINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-741-4321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 1248511
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------