Healthcare Provider Details

I. General information

NPI: 1427152040
Provider Name (Legal Business Name): NORMAN ARTHUR ETTENGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST KINGSBRIDGE ROAD JAMES J PETERS VA MEDICAL CENTER
BRONX NY
10468
US

IV. Provider business mailing address

8 GEDNEY ESPLANADE
WHITE PLAINS NY
10605-3513
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone: 914-997-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1244431
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: