Provider Demographics
NPI:1962770156
Name:GREATER NEW YORK FERTILITY PC
Entity type:Organization
Organization Name:GREATER NEW YORK FERTILITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE INCORPORATOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRANDEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-245-5358
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:PLANETARIUM STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-0204
Mailing Address - Country:US
Mailing Address - Phone:646-245-5358
Mailing Address - Fax:
Practice Address - Street 1:4601 GREENPOINT AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1707
Practice Address - Country:US
Practice Address - Phone:212-362-4848
Practice Address - Fax:646-596-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162235207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty