Provider Demographics
NPI:1184808990
Name:CONTEMPORARY OB GYN PHYSICIAN SPECIALISTS PC
Entity type:Organization
Organization Name:CONTEMPORARY OB GYN PHYSICIAN SPECIALISTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-292-6747
Mailing Address - Street 1:3001 EXPRESSWAY DR N
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5301
Mailing Address - Country:US
Mailing Address - Phone:631-292-6747
Mailing Address - Fax:631-292-6767
Practice Address - Street 1:3001 EXPRESSWAY DR N
Practice Address - Street 2:SUITE 116
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5301
Practice Address - Country:US
Practice Address - Phone:631-292-6747
Practice Address - Fax:631-292-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02075923Medicaid
NYCJ2895OtherRAILROAD MEDICARE
NY02075923Medicaid