Provider Demographics
NPI:1073822888
Name:EUGENE J. SIDOTI, JR., MD, PC
Entity Type:Organization
Organization Name:EUGENE J. SIDOTI, JR., MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIDOTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:914-472-7200
Mailing Address - Street 1:688 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5059
Mailing Address - Country:US
Mailing Address - Phone:914-472-7200
Mailing Address - Fax:914-472-7527
Practice Address - Street 1:688 WHITE PLAINS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5059
Practice Address - Country:US
Practice Address - Phone:914-472-7200
Practice Address - Fax:914-472-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1754072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG02813Medicare UPIN