Provider Demographics
NPI:1841661766
Name:WOMEN'S HEALTH OF AMSTERDAM, PLLC
Entity type:Organization
Organization Name:WOMEN'S HEALTH OF AMSTERDAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-843-6613
Mailing Address - Street 1:425 GUY PARK AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1043
Mailing Address - Country:US
Mailing Address - Phone:518-843-6613
Mailing Address - Fax:518-843-0171
Practice Address - Street 1:425 GUY PARK AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1043
Practice Address - Country:US
Practice Address - Phone:518-843-6613
Practice Address - Fax:518-843-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02869212Medicaid