Provider Demographics
NPI:1821062910
Name:NEW ROCHELLE FACULTY GROUP PRACTICE
Entity Type:Organization
Organization Name:NEW ROCHELLE FACULTY GROUP PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-637-1357
Mailing Address - Street 1:16 GUION PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5503
Mailing Address - Country:US
Mailing Address - Phone:914-637-1357
Mailing Address - Fax:914-637-1489
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5503
Practice Address - Country:US
Practice Address - Phone:914-637-1357
Practice Address - Fax:914-637-1489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUND SHORE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEM831Medicare PIN