MEDICARE: MICHAEL D VARDY GYNECOLOGY AND UROGYNECOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	1928071	NY

General Provider Information

NPI Number	:	1033365259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D VARDY GYNECOLOGY AND UROGYNECOLOGY, LLC

Provider Business Mailing Address
First Line	:	7 PARK ST
Second Line	:	APT 8P
City	:	TENAFLY
State	:	NJ
Zip	:	07670-2217
Country	:	US
Telephone Number	:	646-345-5249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 5TH AVE
Second Line	:	STE 1E
City	:	NEW YORK
State	:	NY
Zip	:	10128-0145
Country	:	US
Telephone Number	:	646-345-5249
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL D VARDY
Credential	:	MD
Telephone Number	:	646-345-5249

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	02/01/2011

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