MEDICARE: EVERY WOMAN WELLNESS MEDICAL & PAIN MANAGEMENT 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	207L00000X	Anesthesiology Physician		NY
2	207V00000X	Obstetrics & Gynecology Physician		NY

General Provider Information

NPI Number	:	1497090237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERY WOMAN WELLNESS MEDICAL & PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	1375 BROADWAY
Second Line	:	SUITE 506
City	:	NEW YORK
State	:	NY
Zip	:	10018-7001
Country	:	US
Telephone Number	:	212-302-4399
Fax Number	:	212-302-2582

Provider Business Practice Location Address
First Line	:	1375 BROADWAY
Second Line	:	SUITE 506
City	:	NEW YORK
State	:	NY
Zip	:	10018-7001
Country	:	US
Telephone Number	:	212-302-4399
Fax Number	:	212-302-2582

Authorized Official
Title or Position	:	PARTNER
Name	:	JUANA CUEVAS
Credential	:	MD
Telephone Number	:	212-302-4399

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/09/2013

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