Provider Demographics
NPI:1245728658
Name:MOMS OB-GYN PC
Entity type:Organization
Organization Name:MOMS OB-GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DELEGATED OFFICIAL
Authorized Official - Phone:516-424-7919
Mailing Address - Street 1:503 CLEARMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1224
Mailing Address - Country:US
Mailing Address - Phone:516-424-7919
Mailing Address - Fax:
Practice Address - Street 1:120 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-513-1004
Practice Address - Fax:516-390-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236736207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty