Provider Demographics
NPI:1932334372
Name:WILLIAMSBURG OB GYN PC
Entity Type:Organization
Organization Name:WILLIAMSBURG OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDIENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-427-4111
Mailing Address - Street 1:1619 3RD AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3461
Mailing Address - Country:US
Mailing Address - Phone:212-427-4111
Mailing Address - Fax:
Practice Address - Street 1:6620 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3314
Practice Address - Country:US
Practice Address - Phone:718-381-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235252261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical