Provider Demographics
NPI:1265578967
Name:IWANIW, I. ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:I. ALEX
Middle Name:
Last Name:IWANIW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IHOR
Other - Middle Name:ALEX
Other - Last Name:IWANIW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 DAYTON LN STE 202
Mailing Address - Street 2:THE WESTCHESTER MEDICAL PRACTICE PC
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2860
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:211 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3611
Practice Address - Country:US
Practice Address - Phone:914-736-0400
Practice Address - Fax:845-265-3664
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181599-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE98537Medicare UPIN