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General NPI Number Information
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NPI Number | 1932334372
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG OB GYN PC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 6620 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-3314
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Country | US
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Telephone | 718-381-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 1619 3RD AVE APT 7B
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City | NEW YORK
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State | NY
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Zip | 10128-3461
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Country | US
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Telephone | 212-427-4111
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Fax |
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Authorized Official
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Title or Position | ATTENDING
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Name | DR. STEPHANIE L GORDIENKO
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Credential | M.D
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Telephone | 212-427-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 235252
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License Number State | NY
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