Provider Demographics
NPI:1295807832
Name:WOMEN'S HEALTH & WELLNESS OF LONG ISLAND, PLLC
Entity type:Organization
Organization Name:WOMEN'S HEALTH & WELLNESS OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-921-5900
Mailing Address - Street 1:155 FROEHLICH FARM BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2906
Mailing Address - Country:US
Mailing Address - Phone:516-921-5900
Mailing Address - Fax:516-921-4890
Practice Address - Street 1:155 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2906
Practice Address - Country:US
Practice Address - Phone:516-921-5900
Practice Address - Fax:516-921-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB88439Medicare UPIN