Healthcare Provider Details

I. General information

NPI: 1194390146
Provider Name (Legal Business Name): WESTCHESTER MYOFUNCTIONAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 WHITE PLAINS RD STE 250
SCARSDALE NY
10583-5030
US

IV. Provider business mailing address

774 WHITE PLAINS RD STE 250
SCARSDALE NY
10583-5030
US

V. Phone/Fax

Practice location:
  • Phone: 914-348-3486
  • Fax:
Mailing address:
  • Phone: 914-348-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. HETAL SUTARIA
Title or Position: MYOFUNCTIONAL THERAPIST
Credential:
Phone: 914-439-7837