=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245451525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTCHESTER O B S, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 12/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 SAW MILL RIVER RD 2ND FLOOR
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
Fax | 914-245-7909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 SAW MILL RIVER RD
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
Fax | 914-245-7909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WAYNE BLOOM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 914-245-7888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | N004712
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | N004707
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------