Provider Demographics
NPI:1083984496
Name:GATEWAY OB/GYN ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:GATEWAY OB/GYN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES. / SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:PRUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-987-9175
Mailing Address - Street 1:78 CROMWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-987-9175
Mailing Address - Fax:718-987-1678
Practice Address - Street 1:78 CROMWELL AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-987-9175
Practice Address - Fax:718-987-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty