1194022962 NPI number — SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC

Table of content: (NPI 1194022962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194022962 NPI number — SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP 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:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1194022962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
664 STONELEIGH AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-278-8400
Provider Business Mailing Address Fax Number:
845-278-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CHAPIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWLING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12564-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-493-0420
Provider Business Practice Location Address Fax Number:
845-493-0314
Provider Enumeration Date:
02/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUCHALTER
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
845-278-8400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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