Provider Demographics
NPI:1063697704
Name:MESDAME OB/GYN PC
Entity type:Organization
Organization Name:MESDAME OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAURISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-423-0025
Mailing Address - Street 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 506
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-423-0025
Practice Address - Fax:914-423-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02889930Medicaid