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General NPI Number Information
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NPI Number | 1427147099
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Entity Type | Organization
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Legal Business Name | SOUTHERN WESTCHESTER DERMATOLOGY PC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 1 ELM STREET PARKWAY PLAZA MEDICAL CENTER SUITE 2B
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City | TUCKAHOE
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State | NY
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Zip | 10707
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Country | US
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Telephone | 914-337-9100
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Fax | 914-337-9485
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Provider Business Mailing Address
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Address Line | 1 ELM STREET PARKWAY PLAZA MEDICAL CENTER SUITE 2B
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City | TUCKAHOE
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State | NY
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Zip | 10707
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Country | US
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Telephone | 914-337-9100
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Fax | 914-337-9485
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ELLEN DONNA TEPLITZ
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Credential | MD
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Telephone | 914-337-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 1564121
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License Number State | NY
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