Provider Demographics
NPI:1053509992
Name:NORTH VILLAGE OB/GYN PC
Entity Type:Organization
Organization Name:NORTH VILLAGE OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-354-7100
Mailing Address - Street 1:925 HEMPSTEAD TPKE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3641
Mailing Address - Country:US
Mailing Address - Phone:516-354-7100
Mailing Address - Fax:
Practice Address - Street 1:925 HEMPSTEAD TPKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3641
Practice Address - Country:US
Practice Address - Phone:516-354-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156347173000000X
NY197740173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06786Medicare PIN