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General NPI Number Information
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NPI Number | 1962516823
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Entity Type | Organization
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Legal Business Name | WOMENS SURGICAL BOUTIQUE INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 112 B BROADWAY
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City | MALVERNE
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State | NY
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Zip | 11565-1652
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Country | US
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Telephone | 516-292-1320
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Fax | 516-292-1323
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Provider Business Mailing Address
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Address Line | 112 B BROADWAY
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City | MALVERNE
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State | NY
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Zip | 11565-1652
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Country | US
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Telephone | 516-292-1320
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Fax | 516-292-1323
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANE E LIPMAN
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Credential | CMF
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Telephone | 516-292-1320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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