Provider Demographics
NPI:1730281759
Name:JOSEPH C. BOTTINO, MD PC
Entity Type:Organization
Organization Name:JOSEPH C. BOTTINO, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-244-4161
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-244-4161
Mailing Address - Fax:914-241-7166
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-244-4161
Practice Address - Fax:914-241-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133637-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEL141Medicare ID - Type UnspecifiedMEDICARE
NYWEL142Medicare ID - Type UnspecifiedMT. KISCO PC ID