| NPI | 1023675220 |
|---|---|
| Former Legal Business Name | SHADY GROVE FERTILITY NEW YORK MEDICAL PROFESSIONALS, PLLC |
| Entity Type | Organization |
| Authorized Contact | SHELLY SHAPIRO Chief Financial Officer 301-545-1407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-08-13 |