Healthcare Provider Details

I. General information

NPI: 1609048537
Provider Name (Legal Business Name): SOUTHERN WESTCHESTER ORTHOPEDICS & SPORTS MEDICINE ASSOC. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 NORTH BROADWAY SUITE 204
YONKERS NY
10701-1310
US

IV. Provider business mailing address

970 NORTH BROADWAY SUITE 204
YONKERS NY
10701-1310
US

V. Phone/Fax

Practice location:
  • Phone: 914-476-4343
  • Fax:
Mailing address:
  • Phone: 914-476-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1212224
License Number StateNY

VIII. Authorized Official

Name: MS. ANNE FORMATO
Title or Position: MANAGER
Credential:
Phone: 914-476-4343