Provider Demographics
NPI:1417938192
Name:WERTHEIM, IRIS (MD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-666-2513
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:CAREMOUNT MEDICAL, PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-666-2513
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039006207VX0201X
NY202735-1207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010202735NY03OtherBLUE CROSS BLUE SHIELD
NY50U06GW701OtherMEDICARE ID -TYPE UNSPECI
NYP00299044OtherRAILROAD MEDICARE
NYA400071866OtherMEDICAR PTAN
NY01685987Medicaid
NYP00299044OtherRAILROAD MEDICARE
CTG37456Medicare UPIN
NY01685987Medicaid
NY010202735NY03OtherBLUE CROSS BLUE SHIELD
CT160002219Medicare ID - Type Unspecified