Healthcare Provider Details

I. General information

NPI: 1417938192
Provider Name (Legal Business Name): IRIS WERTHEIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST CAREMOUNT MEDICAL, PC
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

110 S BEDFORD RD CAREMOUNT MEDICAL, PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-666-2513
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-666-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number039006
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number202735-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: