Provider Demographics
NPI:1114124658
Name:NYCONN ORTHOPAEDIC & REHABILITATION SPCECIALISTS, PLLC
Entity Type:Organization
Organization Name:NYCONN ORTHOPAEDIC & REHABILITATION SPCECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOWDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-684-6113
Mailing Address - Street 1:2900 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2552
Mailing Address - Country:US
Mailing Address - Phone:914-249-7000
Mailing Address - Fax:914-249-7034
Practice Address - Street 1:NORTHERN WESTCHESTER HOSPITAL
Practice Address - Street 2:400 EAST MAIN STREET, SUITE 100
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1725
Practice Address - Fax:718-652-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02736625009Medicaid
NYWCK261Medicare PIN