=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114124658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NYCONN ORTHOPAEDIC & REHABILITATION SPCECIALISTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 11/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NORTHERN WESTCHESTER HOSPITAL 400 EAST MAIN STREET, SUITE 100
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-666-1725
-----------------------------------------------------
Fax | 718-652-0815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 WESTCHESTER AVE SUITE 307
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-2552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-249-7000
-----------------------------------------------------
Fax | 914-249-7034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | JOHN D. DOWDLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 914-684-6113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------