Provider Demographics
NPI:1134233307
Name:PENFIELD OBSTETRICS AND GYNECOLOGY LLP
Entity type:Organization
Organization Name:PENFIELD OBSTETRICS AND GYNECOLOGY LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUISTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-377-5420
Mailing Address - Street 1:43 WILLOW POND WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2638
Mailing Address - Country:US
Mailing Address - Phone:585-377-5420
Mailing Address - Fax:585-377-3690
Practice Address - Street 1:43 WILLOW POND WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2638
Practice Address - Country:US
Practice Address - Phone:585-377-5420
Practice Address - Fax:585-377-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0942Medicare PIN