1447257514 NPI number — STEVEN WALTER MEDWID M.D.

Table of content: STEVEN WALTER MEDWID M.D. (NPI 1447257514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447257514 NPI number — STEVEN WALTER MEDWID M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDWID
Provider First Name:
STEVEN
Provider Middle Name:
WALTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDWID
Provider Other First Name:
STEVEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447257514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BRADHURST AVE
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10532-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-2500
Provider Business Mailing Address Fax Number:
914-493-1195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 BRADHURST AVE
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10532-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-493-2500
Provider Business Practice Location Address Fax Number:
914-493-1195
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  81262 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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