MEDICARE: GREENWICH OB/GYN MEDICAL P.C.

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	174400000X	Specialist	2133321	NY

General Provider Information

NPI Number	:	1124002027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWICH OB/GYN MEDICAL P.C.

Provider Business Mailing Address
First Line	:	575 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6102
Country	:	US
Telephone Number	:	646-962-3400
Fax Number	:	646-588-2661

Provider Business Practice Location Address
First Line	:	40 WORTH ST
Second Line	:	SUITE 402
City	:	NEW YORK
State	:	NY
Zip	:	10013-2904
Country	:	US
Telephone Number	:	646-962-3400
Fax Number	:	646-588-2661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PO CHING FONG
Credential	:	MD
Telephone Number	:	646-256-3743

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	03/23/2012

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