Provider Demographics
NPI:1275855900
Name:VILLAGE OBSTETRICS, LLC
Entity Type:Organization
Organization Name:VILLAGE OBSTETRICS, LLC
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:212-741-2228
Mailing Address - Fax:212-741-2228
Practice Address - Street 1:1225 PARK AVE STE 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1758
Practice Address - Country:US
Practice Address - Phone:212-741-2229
Practice Address - Fax:212-741-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2114481207V00000X
NY198008-1207VM0101X
207VM0101X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty