1699971101 NPI number — WESTCHESTER VITREO RETINAL, PC

Table of content: (NPI 1699971101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699971101 NPI number — WESTCHESTER VITREO RETINAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTCHESTER VITREO RETINAL, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699971101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 PURCHASE ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
RYE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10580-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-967-5539
Provider Business Mailing Address Fax Number:
914-967-7149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 PURCHASE ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
RYE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10580-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-967-5539
Provider Business Practice Location Address Fax Number:
914-967-7149
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KALKUT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
912-967-5539

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  18998 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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