Provider Demographics
NPI:1265711972
Name:BEACON HILL ORTHOPEDICS PLLC
Entity type:Organization
Organization Name:BEACON HILL ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:914-693-9400
Mailing Address - Street 1:20 BEACON HILL DR
Mailing Address - Street 2:STE 2A
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2402
Mailing Address - Country:US
Mailing Address - Phone:914-693-9400
Mailing Address - Fax:914-693-4793
Practice Address - Street 1:20 BEACON HILL DR
Practice Address - Street 2:STE 2A
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2402
Practice Address - Country:US
Practice Address - Phone:914-693-9400
Practice Address - Fax:914-693-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257342207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty