MEDICARE: WOMENS MEDICAL SERVICES OF NEW YORK PC

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	173000000X	Legal Medicine	60 66418	NY

General Provider Information

NPI Number	:	1184873572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS MEDICAL SERVICES OF NEW YORK PC

Provider Business Mailing Address
First Line	:	2 BARNES LN
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4402
Country	:	US
Telephone Number	:	718-485-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	9413 FLATLANDS AVE
Second Line	:	SUITE 206
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3726
Country	:	US
Telephone Number	:	718-485-2420
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	JUAN SANDOVAL
Credential	:
Telephone Number	:	718-485-2420

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	02/12/2013

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