Provider Demographics
NPI:1376655621
Name:SOUTH BAY OBGYN PC
Entity Type:Organization
Organization Name:SOUTH BAY OBGYN PC
Other - Org Name:SOUTH BAY OBSTETRICS GYNECOLOGY PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN PRESIDENT OF PC
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-587-2500
Mailing Address - Street 1:320 MONTAUK HWY
Mailing Address - Street 2:SOUTH BAY OBGYN PC
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4401
Mailing Address - Country:US
Mailing Address - Phone:631-587-2500
Mailing Address - Fax:631-587-0292
Practice Address - Street 1:320 MONTAUK HWY
Practice Address - Street 2:SOUTH BAY OBGYN PC
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4401
Practice Address - Country:US
Practice Address - Phone:631-587-2500
Practice Address - Fax:631-587-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty