Provider Demographics
NPI:1629368790
Name:AUSTIN SURGERY PROFESSIONAL GYNECOLOGICAL OFFICE BASED SURGERY
Entity Type:Organization
Organization Name:AUSTIN SURGERY PROFESSIONAL GYNECOLOGICAL OFFICE BASED SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-526-1839
Mailing Address - Street 1:6902 AUSTIN ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4233
Mailing Address - Country:US
Mailing Address - Phone:718-526-1839
Mailing Address - Fax:718-497-7057
Practice Address - Street 1:6902 AUSTIN ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4233
Practice Address - Country:US
Practice Address - Phone:718-526-1839
Practice Address - Fax:718-497-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3632261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical