Healthcare Provider Details

I. General information

NPI: 1023238714
Provider Name (Legal Business Name): MOUNT KISCO MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 COMMERCE ST SUITE 201
YORKTOWN HTS NY
10598-4428
US

IV. Provider business mailing address

90 S BEDFORD RD
MOUNT KISCO NY
10549-3412
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-5577
  • Fax:
Mailing address:
  • Phone: 914-241-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MONACO
Title or Position: BILLING DIRECTOR
Credential:
Phone: 914-241-1050