1720305071 NPI number — PULMONARY DISEASE GROUP OF WESTCHESTER PLLC

Table of content: (NPI 1720305071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720305071 NPI number — PULMONARY DISEASE GROUP OF WESTCHESTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY DISEASE GROUP OF WESTCHESTER PLLC
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:
ROBERT E. DEMATTEO MBR
Provider Other Organization Name Type Code:
5
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:
1720305071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 NORTH BROADWAY
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-965-3366
Provider Business Mailing Address Fax Number:
914-965-1310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-965-3366
Provider Business Practice Location Address Fax Number:
914-965-1310
Provider Enumeration Date:
04/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEMATTEO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ENRICO
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
914-965-3366

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  260823 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 234613 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 260823 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 120565 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 173247 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 156006 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 234613 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 120565 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 234613 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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