Healthcare Provider Details

I. General information

NPI: 1376969964
Provider Name (Legal Business Name): NORTHERN WESTCHESTER MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-8318
  • Fax: 914-666-1965
Mailing address:
  • Phone: 914-242-8318
  • Fax: 914-666-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN PARTENZA
Title or Position: CFO
Credential:
Phone: 914-666-1310