Organization
MYRTLE STREET OBSTETRICS AND GYNECOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOUISE WEST (PRACTICE ADMINISTRATOR)
(518) 587-5304
Entity
Organization
Contact information
Practice address
2105 ELLSWORTH BLVD, MALTA, NY 12020
(518) 587-2400
(518) 581-0141
Mailing address
59 MYRTLE ST, SARATOGA SPRINGS, NY 12866-1093
(518) 587-2400
(518) 581-0141
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
189300-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01877009
—
NY
Enumeration date
03/27/2012
Last updated
03/27/2012
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