Provider Demographics
NPI:1407250624
Name:MOUNT VERNON MEDICAL PRACTICE
Entity Type:Organization
Organization Name:MOUNT VERNON MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-668-8080
Mailing Address - Street 1:153 STEVENS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2543
Mailing Address - Country:US
Mailing Address - Phone:914-668-8080
Mailing Address - Fax:914-668-0629
Practice Address - Street 1:153 STEVENS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2543
Practice Address - Country:US
Practice Address - Phone:914-668-8080
Practice Address - Fax:914-668-0629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER ADUBOR PHYSICIAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338574-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care