Provider Demographics
NPI:1811074032
Name:WOMEN FIRST OB GYN PC
Entity type:Organization
Organization Name:WOMEN FIRST OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:CORDELLLA
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-682-4212
Mailing Address - Street 1:8417 HOBNAIL RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9332
Mailing Address - Country:US
Mailing Address - Phone:315-682-4212
Mailing Address - Fax:
Practice Address - Street 1:36381 NYS ROUTE 26
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619
Practice Address - Country:US
Practice Address - Phone:315-493-9195
Practice Address - Fax:315-493-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188409207VX0000X
NY1932051207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810306Medicaid
NY56767AMedicare UPIN