Provider Demographics
NPI:1902575921
Name:EQUAL WOMEN MATERNAL FETAL MEDICINE SPECIALIST PLLC
Entity Type:Organization
Organization Name:EQUAL WOMEN MATERNAL FETAL MEDICINE SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-230-1180
Mailing Address - Street 1:224 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2320
Mailing Address - Country:US
Mailing Address - Phone:917-826-1353
Mailing Address - Fax:
Practice Address - Street 1:224 FOREST DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2320
Practice Address - Country:US
Practice Address - Phone:917-826-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty