# NEW MOM'S OF GREEN BAY SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558534313
- **Authorized official:** ALLAHYAR JAZAYERI M.D. (PRESIDENT/OWNER)
- **Authorized official phone:** (920) 338-6868

## Contact information

- **Practice address:** 704 S WEBSTER AVE STOP 110, GREEN BAY, WI 54301-3528
- **Practice address phone:** (920) 431-0200
- **Practice address fax:** (920) 431-0300
- **Mailing address:** 704 S WEBSTER AVE STOP 110, GREEN BAY, WI 54301-3528
- **Mailing address phone:** (920) 431-0200
- **Mailing address fax:** (920) 431-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | 44616020 | WI | Yes |
| 261Q00000X | Clinic/Center | 44616020 | WI | — |

## Other

- **Enumeration date:** 04/11/2008
- **Last updated:** 12/04/2009