Provider Demographics
NPI:1225495427
Name:VILLAGE MATERNITY PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:VILLAGE MATERNITY PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-741-2229
Mailing Address - Street 1:1225 PARK AVE STE 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1758
Mailing Address - Country:US
Mailing Address - Phone:212-741-2229
Mailing Address - Fax:212-741-2228
Practice Address - Street 1:101 W 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8142
Practice Address - Country:US
Practice Address - Phone:212-705-8785
Practice Address - Fax:877-370-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X, 207VX0000X, 367A00000X
NY211448261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty