Healthcare Provider Details

I. General information

NPI: 1558337667
Provider Name (Legal Business Name): DAVID EUGENE BANK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 E MAIN ST STE 4G
MT KISCO NY
10549
US

IV. Provider business mailing address

359 E MAIN ST STE 4G
MT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-3003
  • Fax: 914-241-1525
Mailing address:
  • Phone: 914-241-3003
  • Fax: 914-241-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number168036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: