Healthcare Provider Details

I. General information

NPI: 1649396433
Provider Name (Legal Business Name): SCOLIOSIS AND SPINE SURGERY, P.C,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WESTCHESTER AVE SUITE 316
WHITE PLAINS NY
10604-2907
US

IV. Provider business mailing address

244 WESTCHESTER AVE SUITE 316
WHITE PLAINS NY
10604-2907
US

V. Phone/Fax

Practice location:
  • Phone: 914-288-0045
  • Fax: 914-288-0065
Mailing address:
  • Phone: 914-288-0045
  • Fax: 914-288-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number032861
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number112892
License Number StateNY

VIII. Authorized Official

Name: MS. SANDY SOLOTAROFF
Title or Position: ACCOUNTS SPECIALIST
Credential:
Phone: 914-288-0045