1740481696 NPI number — MS. MARY ELLEN STAVITZ PNP

Table of content: TABATHA WILLIAMS FNP-BC (NPI 1144767625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740481696 NPI number — MS. MARY ELLEN STAVITZ PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAVITZ
Provider First Name:
MARY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

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:
1740481696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 DAYTON LANE, SUITE 202
Provider Second Line Business Mailing Address:
THE WESTCHSTER MEDICAL PRACTICE PC
Provider Business Mailing Address City Name:
PEEKSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-739-0087
Provider Business Mailing Address Fax Number:
914-737-1714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 S RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
THE WESTCHESTER M,EDICAL PRACTICE PC
Provider Business Practice Location Address City Name:
CROTON ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10520-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-271-2424
Provider Business Practice Location Address Fax Number:
914-271-2551
Provider Enumeration Date:
05/29/2007

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: 363LP0200X , with the licence number:  F380031 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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