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General NPI Number Information
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NPI Number | 1992345979
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Entity Type | Organization
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Legal Business Name | KEC 51 LLC
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 51 KATONAH AVE
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City | KATONAH
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State | NY
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Zip | 10536-2103
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Country | US
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Telephone | 914-232-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 51 KATONAH AVE
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City | KATONAH
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State | NY
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Zip | 10536-2103
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Country | US
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Telephone | 914-232-5770
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Fax |
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Authorized Official
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Title or Position | OD
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Name | DR. STEVEN GORDON
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Credential |
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Telephone | 914-232-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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