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General NPI Number Information
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NPI Number | 1003086729
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Entity Type | Organization
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Legal Business Name | NORTHEAST SURGERY PC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 666 LEXINGTON AVE STE 104
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3638
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Country | US
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Telephone | 914-588-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 311 NORTH ST STE 408
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City | WHITE PLAINS
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State | NY
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Zip | 10605-2215
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Country | US
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Telephone | 914-588-2665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN FARELLA
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Credential | MD
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Telephone | 914-588-2665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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