Healthcare Provider Details

I. General information

NPI: 1477551851
Provider Name (Legal Business Name): WALTER E BOTTIZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

210 WESTCHESTER AVE
WHITE PLAINS NY
10604-2901
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8850
  • Fax: 914-682-6403
Mailing address:
  • Phone: 914-682-6538
  • Fax: 914-682-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number114648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: