Provider Demographics
NPI:1578718979
Name:OB-GYN ASSOCIATES OF STATEN ISLAND, P.C.
Entity Type:Organization
Organization Name:OB-GYN ASSOCIATES OF STATEN ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELLITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-668-2096
Mailing Address - Street 1:1984 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2550
Mailing Address - Country:US
Mailing Address - Phone:718-668-2096
Mailing Address - Fax:718-667-1388
Practice Address - Street 1:1984 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2550
Practice Address - Country:US
Practice Address - Phone:718-668-2096
Practice Address - Fax:718-667-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001316Medicare PIN