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General NPI Number Information
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NPI Number | 1821742487
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND REPRODUCTIVE MEDICINE PLLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1441 SOUTH AVE # 201
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3425
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Country | US
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Telephone | 973-548-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 94 OLD SHORT HILLS RD STE 403
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-548-0900
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Fax |
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Authorized Official
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Title or Position | FINANCE MANAGER
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Name | LISA MILLER
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Credential |
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Telephone | 732-317-8286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State |
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