Healthcare Provider Details

I. General information

NPI: 1144807835
Provider Name (Legal Business Name): ALICE KWON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE # 200
HARRISON NY
10528-1635
US

IV. Provider business mailing address

600 MAMARONECK AVE # 200
HARRISON NY
10528-1635
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-8100
  • Fax:
Mailing address:
  • Phone: 914-723-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number328860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: