Provider Demographics
NPI:1801077193
Name:LONG ISLAND WOMEN'S HEALTH CARE GROUP, PC
Entity type:Organization
Organization Name:LONG ISLAND WOMEN'S HEALTH CARE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-741-4321
Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 200-202
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-741-4321
Mailing Address - Fax:516-535-1332
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 200-202
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-741-4321
Practice Address - Fax:516-535-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1248511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255418786OtherNPI
NY1740486372OtherNPI
NY1821249574OtherNPI
NY1902977796OtherNPI
NY1780753830OtherNPI
NYC08963Medicare UPIN