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General NPI Number Information
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NPI Number | 1033416342
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Entity Type | Organization
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Legal Business Name | SOUTHERN WESTCHESTER NEPHROLOGY PLLC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 136 S BROADWAY
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City | YONKERS
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State | NY
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Zip | 10701-4008
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Country | US
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Telephone | 914-965-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 24 PARKFIELD RD
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City | SCARSDALE
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State | NY
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Zip | 10583-1616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMINICK FRANK REDA
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Credential | M.D.
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Telephone | 914-965-0621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 168949
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License Number State | NY
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