Provider Demographics
NPI:1457451601
Name:WOMENS ROOM OBGYN PLLC
Entity Type:Organization
Organization Name:WOMENS ROOM OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-265-2153
Mailing Address - Street 1:445 FACTORY ST
Mailing Address - Street 2:PO BOX 91
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2729
Mailing Address - Country:US
Mailing Address - Phone:315-782-4207
Mailing Address - Fax:315-782-8699
Practice Address - Street 1:190 OUTER MAIN ST
Practice Address - Street 2:NATCO BUILDING
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2324
Practice Address - Country:US
Practice Address - Phone:315-265-2153
Practice Address - Fax:315-265-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156476207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA1230Medicare PIN