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NPI Code Detail

MEDICARE: SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC

MEDICARE: SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CK5665OTHERNYMEDICARE RAILROAD

General Provider Information

NPI Number : 1720028384
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC
Provider Business Mailing Address
First Line : 664 STONELEIGH AVE STE 300
Second Line :
City : CARMEL
State : NY
Zip : 10512-3990
Country : US
Telephone Number : 845-278-8400
Fax Number : 845-278-4326
Provider Business Practice Location Address
First Line : 664 STONELEIGH AVE STE 300
Second Line :
City : CARMEL
State : NY
Zip : 10512-3990
Country : US
Telephone Number : 845-278-8400
Fax Number : 845-278-4326
Authorized Official
Title or Position : PRESIDENT
Name : JOEL BUCHALTER
Credential : MD
Telephone Number : 845-278-8400
Provider Enumeration Date : 06/08/2006
Last Update Date : 06/26/2013

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Practice Location Address:
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Directions to “SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC ” Practice Location

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