Provider Demographics
NPI:1033365259
Name:MICHAEL D VARDY GYNECOLOGY AND UROGYNECOLOGY, LLC
Entity Type:Organization
Organization Name:MICHAEL D VARDY GYNECOLOGY AND UROGYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:VARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-345-5249
Mailing Address - Street 1:7 PARK ST
Mailing Address - Street 2:APT 8P
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2217
Mailing Address - Country:US
Mailing Address - Phone:646-345-5249
Mailing Address - Fax:
Practice Address - Street 1:1107 5TH AVE
Practice Address - Street 2:STE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0145
Practice Address - Country:US
Practice Address - Phone:646-345-5249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1928071207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty