Provider Demographics
NPI:1578633822
Name:NY QUEENS OB-GYN
Entity Type:Organization
Organization Name:NY QUEENS OB-GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-751-5724
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-0189
Mailing Address - Country:US
Mailing Address - Phone:631-321-8043
Mailing Address - Fax:631-321-4235
Practice Address - Street 1:13336 41ST RD
Practice Address - Street 2:SUITE 2L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:718-321-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02687Medicare PIN