Provider Demographics
NPI:1598369589
Name:AMERICAN ENDOMETRIOSIS PC
Entity Type:Organization
Organization Name:AMERICAN ENDOMETRIOSIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-584-8710
Mailing Address - Street 1:135 PINELAWN RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3198
Mailing Address - Country:US
Mailing Address - Phone:516-584-8710
Mailing Address - Fax:516-584-8711
Practice Address - Street 1:155 E 76TH ST # 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2810
Practice Address - Country:US
Practice Address - Phone:516-584-8710
Practice Address - Fax:516-584-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1912089277OtherNPI