Provider Demographics
NPI:1356432348
Name:WOMENS HEALTH SERVICES OF ELMIRA
Entity type:Organization
Organization Name:WOMENS HEALTH SERVICES OF ELMIRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-734-8157
Mailing Address - Street 1:600 FITCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905
Mailing Address - Country:US
Mailing Address - Phone:607-734-8157
Mailing Address - Fax:607-735-9579
Practice Address - Street 1:600 FITCH ST SU 102
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905
Practice Address - Country:US
Practice Address - Phone:607-734-8157
Practice Address - Fax:607-735-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1699031207V00000X
NY2143571207V00000X
NYF3306811207V00000X
NYF3344451207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01281805Medicaid
NY01281805Medicaid
F57456Medicare UPIN
NY34743AMedicare ID - Type Unspecified