Provider Demographics
NPI:1447211552
Name:NORTHEAST UROGYNECOLOGY PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:NORTHEAST UROGYNECOLOGY PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-438-5538
Mailing Address - Street 1:5 PALISADES DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-6433
Mailing Address - Country:US
Mailing Address - Phone:518-438-5538
Mailing Address - Fax:518-438-6104
Practice Address - Street 1:5 PALISADES DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6433
Practice Address - Country:US
Practice Address - Phone:518-438-5538
Practice Address - Fax:518-438-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01679381Medicaid
NYG33908Medicare UPIN
4715120001Medicare NSC
NYAA0825Medicare PIN
4715120001Medicare NSC