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General NPI Number Information
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NPI Number | 1851571251
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Entity Type | Organization
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Legal Business Name | LAKE SUCCESS WOMEN'S MEDICAL CARE
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 1999 MARCUS AVE SUITE 108
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1017
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Country | US
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Telephone | 516-466-3663
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Fax | 516-773-3201
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Provider Business Mailing Address
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Address Line | 1999 MARCUS AVE SUITE 108
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1017
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Country | US
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Telephone | 516-466-3663
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Fax | 516-773-3201
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROBERT A JASON
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Credential | M.D.
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Telephone | 516-466-3663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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