| Organization Name: | SOUTH NASSAU OBSTETRICS & GYNECOLOGY, PC |
| NPI Number: | 1043570286 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK BOGEN (CFO) |
| Mailing Address: | 1 S Central Ave Valley Stream |
| State: | NY US |
| Postal Code: | 115805443 |
| Phone Number: | 5166323350 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2012 |
| NPI Last Update Date: | 03/25/2015 |
| 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: | |