Healthcare Provider Details

I. General information

NPI: 1831274208
Provider Name (Legal Business Name): MT KISCO SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SOUTH BEDFORD ROAD
MT KISCO NY
10549
US

IV. Provider business mailing address

34 SOUTH BEDFORD ROAD
MT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-244-6789
  • Fax: 914-244-6766
Mailing address:
  • Phone: 914-244-6789
  • Fax: 914-244-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number5946202R
License Number StateNY

VIII. Authorized Official

Name: MRS. DONNA MOCCIO
Title or Position: ADMINISTRATOR
Credential: RN CASC
Phone: 914-244-6785