Basic Information
Provider Information
NPI: 1114124658
EntityType: 2
ReplacementNPI:  
OrganizationName: NYCONN ORTHOPAEDIC & REHABILITATION SPCECIALISTS, PLLC
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Mailing Information
Address1: 2900 WESTCHESTER AVE
Address2: SUITE 307
City: PURCHASE
State: NY
PostalCode: 105772552
CountryCode: US
TelephoneNumber: 9142497000
FaxNumber: 9142497034
Practice Location
Address1: NORTHERN WESTCHESTER HOSPITAL
Address2: 400 EAST MAIN STREET, SUITE 100
City: MOUNT KISCO
State: NY
PostalCode: 10549
CountryCode: US
TelephoneNumber: 9146661725
FaxNumber: 7186520815
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 11/03/2008
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AuthorizedOfficialLastName: DOWDLE
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: D.
AuthorizedOfficialTitleorPosition: MANAGING MEMBER
AuthorizedOfficialTelephone: 9146846113
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
0273662500905NY MEDICAID


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