Healthcare Provider Details

I. General information

NPI: 1225099211
Provider Name (Legal Business Name): EDWARD L. SOCOLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GOLDENS BRIDGE RD
KATONAH NY
10536-3447
US

IV. Provider business mailing address

190 GOLDENS BRIDGE RD
KATONAH NY
10536-2810
US

V. Phone/Fax

Practice location:
  • Phone: 914-401-8053
  • Fax: 914-232-3366
Mailing address:
  • Phone: 914-401-8053
  • Fax: 914-232-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number102-922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: