Healthcare Provider Details

I. General information

NPI: 1003086729
Provider Name (Legal Business Name): NORTHEAST SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 LEXINGTON AVE STE 104
MOUNT KISCO NY
10549-3638
US

IV. Provider business mailing address

311 NORTH ST STE 408
WHITE PLAINS NY
10605-2215
US

V. Phone/Fax

Practice location:
  • Phone: 914-588-2665
  • Fax:
Mailing address:
  • Phone: 914-588-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN FARELLA
Title or Position: OWNER
Credential: MD
Phone: 914-588-2665