Provider Demographics
NPI:1003086729
Name:NORTHEAST SURGERY PC
Entity Type:Organization
Organization Name:NORTHEAST SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-588-2665
Mailing Address - Street 1:311 NORTH ST STE 408
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2215
Mailing Address - Country:US
Mailing Address - Phone:914-588-2665
Mailing Address - Fax:
Practice Address - Street 1:666 LEXINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3638
Practice Address - Country:US
Practice Address - Phone:914-588-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163861-1OtherLICENSE
NYE98544OtherUPIN