Healthcare Provider Details

I. General information

NPI: 1851311658
Provider Name (Legal Business Name): THEODORE J SIFONTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

IV. Provider business mailing address

107 W 4TH ST
MOUNT VERNON NY
10550-4002
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-7200
  • Fax: 914-699-0837
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number169644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: