Healthcare Provider Details

I. General information

NPI: 1710048954
Provider Name (Legal Business Name): BOZENNA WESTERFIELD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

523 AVENUE OF THE AMERICAS 4TH FLOOR
NEW YORK NY
10011-8420
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6104
  • Fax:
Mailing address:
  • Phone: 212-691-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number215999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: