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Organization
WOMENS SURGICAL BOUTIQUE INC
Active
Organization
WOMENS SURGICAL BOUTIQUE INC
Active
Other names
Womens Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE E LIPMAN CMF (PRESIDENT)
(516) 292-1320
Entity
Organization
Contact information
Practice address
112 B BROADWAY, MALVERNE, NY 11565-1652
(516) 292-1320
(516) 292-1323
Mailing address
112 B BROADWAY, MALVERNE, NY 11565-1652
(516) 292-1320
(516) 292-1323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0261320001
—
NY
01
—
12DME0747NY
ANTHEM
—
01
—
1C4485
HEALTH NET
—
01
—
603482
AETNA
—
01
—
A382561
OXFORD
—
01
—
AZ00250
MDNY
—
01
—
G71541
EMPIRE BCBS
—
Enumeration date
08/18/2006
Last updated
01/26/2016
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