Provider Demographics
NPI:1871788687
Name:EAST SHORE WOMEN'S CARE, PC
Entity type:Organization
Organization Name:EAST SHORE WOMEN'S CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-539-2646
Mailing Address - Street 1:3907 PRINCE ST
Mailing Address - Street 2:4J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5308
Mailing Address - Country:US
Mailing Address - Phone:516-829-0788
Mailing Address - Fax:
Practice Address - Street 1:3907 PRINCE ST
Practice Address - Street 2:4J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5308
Practice Address - Country:US
Practice Address - Phone:718-539-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty