Healthcare Provider Details

I. General information

NPI: 1598765356
Provider Name (Legal Business Name): THOMAS KALCHTHALER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 S BROADWAY
YONKERS NY
10701-4004
US

IV. Provider business mailing address

69 S BROADWAY
YONKERS NY
10701-4004
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-5555
  • Fax: 914-964-1477
Mailing address:
  • Phone: 914-376-5555
  • Fax: 914-964-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number123328
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number123328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: