Provider Demographics
NPI:1619202264
Name:ANNE MARGOLIS, MIDWIFE P.C.
Entity Type:Organization
Organization Name:ANNE MARGOLIS, MIDWIFE P.C.
Other - Org Name:HOME SWEET HOMEBIRTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE-MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, NP
Authorized Official - Phone:845-364-0105
Mailing Address - Street 1:11 ROBLE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2408
Mailing Address - Country:US
Mailing Address - Phone:845-364-0105
Mailing Address - Fax:
Practice Address - Street 1:11 ROBLE RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-2408
Practice Address - Country:US
Practice Address - Phone:845-364-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000493-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02120785Medicaid
NY02120785Medicaid