1710929476 NPI number — WESTCHESTER PODIATRIC MEDICINE, P.C.

Table of content: (NPI 1710929476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710929476 NPI number — WESTCHESTER PODIATRIC MEDICINE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTCHESTER PODIATRIC MEDICINE, P.C.
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:
1710929476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
984 N BROADWAY,
Provider Second Line Business Mailing Address:
SUITE LL03
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-423-0600
Provider Business Mailing Address Fax Number:
914-424-8338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 N BROADWAY,
Provider Second Line Business Practice Location Address:
SUITE LL03
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-423-0600
Provider Business Practice Location Address Fax Number:
914-424-8338
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARZANO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-423-0600

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  NY003773 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com