Healthcare Provider Details

I. General information

NPI: 1962613802
Provider Name (Legal Business Name): KATHY ANN SILVERMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7555
  • Fax: 914-831-1290
Mailing address:
  • Phone: 914-592-7555
  • Fax: 914-831-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number202851
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02122296
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: