Provider Demographics
NPI:1265622641
Name:OBSTETRICAL AND GYNECOLOGICAL GROUP OF PUTNAM
Entity type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL GROUP OF PUTNAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-279-2000
Mailing Address - Street 1:660 STONELEIGH AVE
Mailing Address - Street 2:HOSPITAL PLAZA
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2451
Mailing Address - Country:US
Mailing Address - Phone:845-279-2000
Mailing Address - Fax:845-279-3887
Practice Address - Street 1:660 STONELEIGH AVE
Practice Address - Street 2:HOSPITAL PLAZA
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2451
Practice Address - Country:US
Practice Address - Phone:845-279-2000
Practice Address - Fax:845-279-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150208OtherLICENSE
NY150208OtherLICENSE
73A721Medicare PIN