Provider Demographics
NPI:1942432893
Name:SOUTHERN WESTCHESTER PEDIATRICS
Entity Type:Organization
Organization Name:SOUTHERN WESTCHESTER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:SAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-667-3030
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:106
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-667-3030
Mailing Address - Fax:914-667-1977
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:106
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-667-3030
Practice Address - Fax:914-667-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01474524Medicaid
F79724Medicare UPIN
NY01474524Medicaid