=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871788687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST SHORE WOMEN'S CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2007
-----------------------------------------------------
Last Update Date | 04/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3907 PRINCE ST 4J
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-539-2646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3907 PRINCE ST 4J
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-829-0788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER REN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-539-2646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 237124
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------