Provider Demographics
NPI:1407932684
Name:BAY SHORE OB GYN GROUP PC
Entity Type:Organization
Organization Name:BAY SHORE OB GYN GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LIPARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-0808
Mailing Address - Street 1:41 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6923
Mailing Address - Country:US
Mailing Address - Phone:631-665-0808
Mailing Address - Fax:631-665-0816
Practice Address - Street 1:41 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6923
Practice Address - Country:US
Practice Address - Phone:631-665-0808
Practice Address - Fax:631-665-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136230207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
70836OtherUSHC AETNA
AG45807OtherMDNY
PM9116OtherBC
4217872OtherAETNA
49221OtherCIGNA
0059757 11068BSOtherGHI
14454OtherVYTRA
NY00642764Medicaid
2154OtherMAGNAHEALTH
PM9116OtherHEALTHNET
2154OtherMAGNAHEALTH
49221OtherCIGNA