Provider Demographics
NPI:1205034634
Name:PREMIER ORTHOPAEDICS OF WESTCHESTER AND ROCKLAND
Entity Type:Organization
Organization Name:PREMIER ORTHOPAEDICS OF WESTCHESTER AND ROCKLAND
Other - Org Name:NEW CITY ORTHOPEDIC GROUP, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-634-7500
Mailing Address - Street 1:350 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3002
Mailing Address - Country:US
Mailing Address - Phone:845-634-7500
Mailing Address - Fax:845-634-7566
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3002
Practice Address - Country:US
Practice Address - Phone:845-634-7500
Practice Address - Fax:845-634-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
W57721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6645440001Medicare NSC