Provider Demographics
NPI:1629266960
Name:ADVANCED WESTCHESTER PODIATRY LLP
Entity Type:Organization
Organization Name:ADVANCED WESTCHESTER PODIATRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-743-1066
Mailing Address - Street 1:1990 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1231
Mailing Address - Country:US
Mailing Address - Phone:914-743-1066
Mailing Address - Fax:914-743-1067
Practice Address - Street 1:1990 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1231
Practice Address - Country:US
Practice Address - Phone:914-743-1066
Practice Address - Fax:914-743-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049892Medicaid
NYWP6451Medicare PIN
NY02049892Medicaid