| Organization Name: | SOUTH ORANGE GYNECOLOGY PC |
| NPI Number: | 1003907072 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERNARD PETER LUCK (OWNER PHYSICIAN) |
| Mailing Address: | 600 Route 208 Monroe |
| State: | NY US |
| Postal Code: | 10950 |
| Phone Number: | 8457827277 |
| Fax Number: | 8457825745 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 09/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VG0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Gynecology |
| Taxonomy Definition: | |