Provider Demographics
NPI:1942301205
Name:DIGESTIVE DISEASE NUTRITION CONSULTANTS OF WESTCHESTER, LLP
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE NUTRITION CONSULTANTS OF WESTCHESTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEMARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-683-1555
Mailing Address - Street 1:2 WESTCHESTER PARK DRIVE.
Mailing Address - Street 2:SUITE L1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604
Mailing Address - Country:US
Mailing Address - Phone:914-683-1555
Mailing Address - Fax:914-683-1026
Practice Address - Street 1:2 WESTCHESTER PARK DRIVE.
Practice Address - Street 2:SUITE L1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604
Practice Address - Country:US
Practice Address - Phone:914-683-1555
Practice Address - Fax:914-683-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY810AY1OtherBLUE CROSS BLUE SHIELD
NY421AQ1OtherBLUE CROSS BLUE SHIELD
NY01365764Medicaid
NY4V9951OtherBLUE CROSS BLUE SHIELD
NY421AP1OtherBLUE CROSS BLUE SHIELD
NY3V8062OtherBLUE CROSS BLUE SHIELD
NYA64699Medicare UPIN
NY56J791Medicare ID - Type Unspecified
NY41J471Medicare ID - Type Unspecified
NY90A461Medicare ID - Type Unspecified
NY421AQ1Medicare ID - Type Unspecified
NY421AP1Medicare ID - Type Unspecified
NY421AQ1OtherBLUE CROSS BLUE SHIELD
NY810AY1OtherBLUE CROSS BLUE SHIELD
NY3V8062Medicare ID - Type Unspecified
NY421AP1OtherBLUE CROSS BLUE SHIELD
NY4V9951OtherBLUE CROSS BLUE SHIELD
NY3V8062OtherBLUE CROSS BLUE SHIELD
NYF91076Medicare UPIN
NY4V9951Medicare ID - Type Unspecified
NY16L441Medicare PIN
NYW32621Medicare UPIN