Provider Demographics
NPI:1427533959
Name:SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC
Entity Type:Organization
Organization Name:SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-278-8400
Mailing Address - Street 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:184-523-0513
Mailing Address - Fax:
Practice Address - Street 1:40 OLD RIDGEBURY RD STE 101
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5119
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCJ511OtherMEDICARE