1063706109 NPI number — COSMETIC PHYSICIANS OF WESTCHESTER, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063706109 NPI number — COSMETIC PHYSICIANS OF WESTCHESTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSMETIC PHYSICIANS 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:
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:
1063706109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 MAMARONECK AVE
Provider Second Line Business Mailing Address:
SUITE 412
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-777-1799
Provider Business Mailing Address Fax Number:
914-777-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 MAMARONECK AVE
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-777-1799
Provider Business Practice Location Address Fax Number:
914-777-1899
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWALD
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
914-328-7802

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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