Healthcare Provider Details

I. General information

NPI: 1063580249
Provider Name (Legal Business Name): SLEEPY HOLLOW MEDICAL GROUP@PHELPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N BROADWAY SUITE 560
SLEEPY HOLLOW NY
10591-1075
US

IV. Provider business mailing address

755 N BROADWAY SUITE 560
SLEEPY HOLLOW NY
10591-1075
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-0337
  • Fax: 914-631-0552
Mailing address:
  • Phone: 914-631-0337
  • Fax: 914-631-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE MENDELOWITZ
Title or Position: PARTNER OWNER
Credential: MEDICAL DOCTOR
Phone: 914-631-0337