Provider Demographics
NPI:1710022140
Name:NY PELVIC PAIN AND MINIMALLY INVASIVE GYNECOLOGIC SURGERY PC
Entity Type:Organization
Organization Name:NY PELVIC PAIN AND MINIMALLY INVASIVE GYNECOLOGIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:646-290-9560
Mailing Address - Street 1:90 MAIDEN LN
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4831
Mailing Address - Country:US
Mailing Address - Phone:646-290-9560
Mailing Address - Fax:
Practice Address - Street 1:90 MAIDEN LN
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4831
Practice Address - Country:US
Practice Address - Phone:646-290-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220289207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89785Medicare UPIN