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General NPI Number Information
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NPI Number | 1013442029
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Entity Type | Organization
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Legal Business Name | OPTUM MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 2 INTERNATIONAL BLVD
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City | BREWSTER
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State | NY
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Zip | 10509
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Country | US
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Telephone | 914-241-1050
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Fax | 914-242-1516
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Provider Business Mailing Address
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Address Line | 110 S. BEDFORD ROAD
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City | MOUNT KISCO
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State | NY
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Zip | 10549
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Country | US
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Telephone | 914-242-5621
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Fax | 914-242-1516
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Authorized Official
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Title or Position | CEO
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Name | SCOTT D HAYWORTH
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Credential |
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Telephone | 914-302-8392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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