Provider Demographics
NPI:1952674129
Name:NEW TOWN OBSTETRICS & GYNECOLOGY, INC.
Entity Type:Organization
Organization Name:NEW TOWN OBSTETRICS & GYNECOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:O
Authorized Official - Last Name:IWUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-944-7565
Mailing Address - Street 1:2200 GRANT ST
Mailing Address - Street 2:STE 207
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3439
Mailing Address - Country:US
Mailing Address - Phone:219-944-7565
Mailing Address - Fax:
Practice Address - Street 1:2200 GRANT ST
Practice Address - Street 2:STE 207
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3439
Practice Address - Country:US
Practice Address - Phone:219-944-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200247520AMedicaid
INB33724Medicare UPIN
IN145710Medicare PIN