Provider Demographics
NPI:1487722518
Name:BROOME OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:BROOME OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-770-7074
Mailing Address - Street 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-770-7074
Mailing Address - Fax:607-770-3452
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-770-7074
Practice Address - Fax:607-770-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52932AMedicare ID - Type Unspecified