Provider Demographics
NPI:1881864528
Name:YORKTOWN ADULT & PEDIATRIC MEDICINE
Entity Type:Organization
Organization Name:YORKTOWN ADULT & PEDIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:FORTUNATO
Authorized Official - Last Name:NOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-245-0256
Mailing Address - Street 1:2000 MAPLE HILL ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4176
Mailing Address - Country:US
Mailing Address - Phone:914-245-0256
Mailing Address - Fax:914-243-0236
Practice Address - Street 1:2000 MAPLE HILL ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4176
Practice Address - Country:US
Practice Address - Phone:914-245-0256
Practice Address - Fax:914-243-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160117302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61D801Medicare PIN
NYA63481Medicare UPIN
NYWJ6251Medicare PIN