Healthcare Provider Details

I. General information

NPI: 1891920799
Provider Name (Legal Business Name): MICHAEL D HEALY PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 MAIN ST.
MT. KISCO NY
10549-3031
US

IV. Provider business mailing address

495 MAIN ST.
MT. KISCO NY
10549-3031
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-6391
  • Fax: 914-666-3825
Mailing address:
  • Phone: 914-666-6391
  • Fax: 914-666-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number145448
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number145448
License Number StateNY

VIII. Authorized Official

Name: MRS. BETSY CURTIS
Title or Position: SECRETARY
Credential:
Phone: 914-666-6391