Healthcare Provider Details

I. General information

NPI: 1386738664
Provider Name (Legal Business Name): NORTHERN WESTCHESTER INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4430
US

IV. Provider business mailing address

1872 COMMERCE ST
YORKTOWN HEIGHTS NY
10598
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-3303
  • Fax: 914-962-4271
Mailing address:
  • Phone: 914-962-3303
  • Fax: 914-962-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number225325
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number101328
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208923
License Number StateNY

VIII. Authorized Official

Name: RICHARD S KLEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 914-962-3303