Provider Demographics
NPI:1942352836
Name:WOMEN'S VIEW GYNECOLOGY-CLOSED
Entity Type:Organization
Organization Name:WOMEN'S VIEW GYNECOLOGY-CLOSED
Other - Org Name:WOMEN'S VIEW GYNECOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3156-334-2500
Mailing Address - Street 1:1200 EAST GENESEE ST-CLOSED
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-452-2500
Mailing Address - Fax:315-634-2503
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1968
Practice Address - Country:US
Practice Address - Phone:315-634-2500
Practice Address - Fax:315-634-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192084207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF69643Medicare UPIN