Provider Demographics
NPI:1104845346
Name:INFERTILITY ASSOCIATES
Entity Type:Organization
Organization Name:INFERTILITY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACOG
Authorized Official - Phone:516-799-3462
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:1130 NORTH BROADWAY
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-799-3462
Mailing Address - Fax:516-799-5930
Practice Address - Street 1:1130 NORTH BROADWAY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-799-3462
Practice Address - Fax:516-799-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty