1992003768 NPI number — PUTNAM WESTCHESTER SURGICAL ASSOCIATES

Table of content: (NPI 1992003768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992003768 NPI number — PUTNAM WESTCHESTER SURGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUTNAM WESTCHESTER SURGICAL ASSOCIATES
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:
1992003768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
672 STONELEIGH AVE
Provider Second Line Business Mailing Address:
SUITE C-116
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512-4634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-582-0911
Provider Business Mailing Address Fax Number:
845-582-0922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 STONELEIGH AVE
Provider Second Line Business Practice Location Address:
SUITE C-116
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10512-4634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-582-0919
Provider Business Practice Location Address Fax Number:
845-582-0922
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CATHCART
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
MCDONNELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-582-0911

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  137996 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 228725 , 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)





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