Provider Demographics
NPI:1518107135
Name:OBSTETRICAL&GYNECOLOGICAL SERVICES OF ROCKVILLE CENTRE, PC
Entity Type:Organization
Organization Name:OBSTETRICAL&GYNECOLOGICAL SERVICES OF ROCKVILLE CENTRE, PC
Other - Org Name:OBSGYN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLINDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-764-5380
Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-764-5380
Mailing Address - Fax:516-764-1915
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-764-5380
Practice Address - Fax:516-764-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143949207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12685Medicare UPIN