Provider Demographics
NPI:1477096436
Name:HEALTHY WOMEN OB/GYN PC
Entity Type:Organization
Organization Name:HEALTHY WOMEN OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-221-0919
Mailing Address - Street 1:1775 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3907
Mailing Address - Country:US
Mailing Address - Phone:718-494-4488
Mailing Address - Fax:718-370-3895
Practice Address - Street 1:1775 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3907
Practice Address - Country:US
Practice Address - Phone:718-841-7392
Practice Address - Fax:718-370-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158738-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty