Healthcare Provider Details

I. General information

NPI: 1043331317
Provider Name (Legal Business Name): NORTHERN WESTCHESTER SURGICAL ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEEKSKILL HOLLOW RD
PUTNAM VALLEY NY
10579-3200
US

IV. Provider business mailing address

11 PEEKSKILL HOLLOW RD PO BOX 97
PUTNAM VALLEY NY
10579-3200
US

V. Phone/Fax

Practice location:
  • Phone: 845-526-2080
  • Fax: 845-526-2082
Mailing address:
  • Phone: 845-526-2080
  • Fax: 845-526-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number236050
License Number StateNY

VIII. Authorized Official

Name: DR. MICHELLE E GORDON
Title or Position: OWNER
Credential: D.O.
Phone: 845-526-2080