Healthcare Provider Details

I. General information

NPI: 1265728679
Provider Name (Legal Business Name): DEEPALI TEWARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GRASSLANDS RD WESTCHESTER MEDICAL CENTER
VALHALLA NY
10595-1503
US

IV. Provider business mailing address

503 GRASSLANDS RD WESTCHESTER MEDICAL CENTER
VALHALLA NY
10595-1503
US

V. Phone/Fax

Practice location:
  • Phone: 914-367-0000
  • Fax:
Mailing address:
  • Phone: 914-367-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number80573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: