Provider Demographics
NPI:1174824882
Name:SHARON OBSTETRICAL,GYNECOLOGICAL,MEDICAL SURGICAL GROUP PLLC
Entity Type:Organization
Organization Name:SHARON OBSTETRICAL,GYNECOLOGICAL,MEDICAL SURGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-364-0536
Mailing Address - Street 1:2510 ROUTE 44 STE 5
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578-8041
Mailing Address - Country:US
Mailing Address - Phone:860-364-0536
Mailing Address - Fax:860-364-1299
Practice Address - Street 1:2510 ROUTE 44 STE 5
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578-8041
Practice Address - Country:US
Practice Address - Phone:860-364-0536
Practice Address - Fax:860-364-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154156-1207V00000X
NY164036-1207V00000X
NY167955-1207V00000X
NY212348-1207V00000X
NY244135208600000X
NY185676208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty