Provider Demographics
NPI:1043331317
Name:NORTHERN WESTCHESTER SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:NORTHERN WESTCHESTER SURGICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-526-2080
Mailing Address - Street 1:11 PEEKSKILL HOLLOW RD
Mailing Address - Street 2:PO BOX 97
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3200
Mailing Address - Country:US
Mailing Address - Phone:845-526-2080
Mailing Address - Fax:845-526-2082
Practice Address - Street 1:11 PEEKSKILL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3200
Practice Address - Country:US
Practice Address - Phone:845-526-2080
Practice Address - Fax:845-526-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236050208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWR251OtherMEDICARE GROUP NUMBER