Provider Demographics
NPI:1396920872
Name:WESTCHESTER DIGESTIVE DISEASE GROUP, LLP
Entity type:Organization
Organization Name:WESTCHESTER DIGESTIVE DISEASE GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-969-1115
Mailing Address - Street 1:469 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1923
Mailing Address - Country:US
Mailing Address - Phone:914-969-1115
Mailing Address - Fax:914-968-0402
Practice Address - Street 1:469 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1923
Practice Address - Country:US
Practice Address - Phone:914-969-1115
Practice Address - Fax:914-968-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132616207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7825OtherPALMETTO GBA
NYWEZ911Medicare PIN