Provider Demographics
NPI:1407928138
Name:WOMEN'S HEALTH & WELLNESS OF QUEENS, PLLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH & WELLNESS OF QUEENS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-281-1800
Mailing Address - Street 1:5515 LITTLE NECK PKWY
Mailing Address - Street 2:SUITE L15
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2244
Mailing Address - Country:US
Mailing Address - Phone:718-281-1800
Mailing Address - Fax:718-281-1802
Practice Address - Street 1:5515 LITTLE NECK PKWY
Practice Address - Street 2:SUITE L15
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2244
Practice Address - Country:US
Practice Address - Phone:718-281-1800
Practice Address - Fax:718-281-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06136Medicare ID - Type Unspecified