Provider Demographics
NPI:1831482546
Name:GUN HILL MEDICAL PAVILION FOR WOMEN, PC
Entity Type:Organization
Organization Name:GUN HILL MEDICAL PAVILION FOR WOMEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-231-7900
Mailing Address - Street 1:1309 E GUN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3003
Mailing Address - Country:US
Mailing Address - Phone:718-231-7900
Mailing Address - Fax:718-231-4474
Practice Address - Street 1:1309 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3003
Practice Address - Country:US
Practice Address - Phone:718-231-7900
Practice Address - Fax:718-231-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145497-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty