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General NPI Number Information
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NPI Number | 1932389517
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Entity Type | Organization
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Legal Business Name | FAMILY OBSTETRICS-GYNECOLOGY PLLC
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 15 HOSPITAL DR SUITE A
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City | MASSENA
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State | NY
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Zip | 13662-1037
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Country | US
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Telephone | 315-769-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HOSPITAL DR SUITE A
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City | MASSENA
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State | NY
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Zip | 13662-1037
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Country | US
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Telephone | 315-769-7777
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL JEAN BRANCHAUD
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Credential | R.N.
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Telephone | 315-769-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 232251
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License Number State | NY
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