Provider Demographics
NPI:1336716059
Name:MATERNITY MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MATERNITY MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-741-2229
Mailing Address - Street 1:1225 PARK AVE # 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1758
Mailing Address - Country:US
Mailing Address - Phone:212-741-2229
Mailing Address - Fax:212-741-2228
Practice Address - Street 1:101 W 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8142
Practice Address - Country:US
Practice Address - Phone:212-705-8785
Practice Address - Fax:212-370-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty