Womens Surgical Boutique Inc

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

WOMENS SURGICAL BOUTIQUE INC

Doing business as

Womens Boutique

Practice address

112 B Broadway
Malverne, NY 11565-1652

Phone

(516) 292-1320

Fax

(516) 292-1323

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Diane E Lipman, CMF

Title

President

Phone

(516) 292-1320

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Womens Boutique Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1962516823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 B BROADWAY",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115651652",
            "telephone_number": "516-292-1320",
            "fax_number": "516-292-1323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 B BROADWAY",
            "city": "MALVERNE",
            "state": "NY",
            "postal_code": "115651652",
            "telephone_number": "516-292-1320",
            "fax_number": "516-292-1323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMENS SURGICAL BOUTIQUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "LIPMAN",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-292-1320",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CMF"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1C4485",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0261320001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A382561",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "12DME0747NY",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "603482",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDNY",
            "identifier": "AZ00250",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "G71541",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Womens Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Weed, MS CCC-SLP, TSSLD
• Yang Wei, LAC, DC
• Christine Elizabeth Weiss, APN-C
• Terry Winston, LMT
• Womens Boutique Inc.
• Christopher Charles Yack, B.S., M.S.
• Sun Sim Yang
• Yogatastic
• Heather Zawislak, MA, LCSW
• Kimberley Zinerco, RPH

• Specialist in Malverne, NY
• Providers in Malverne, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.