Basic Information
| Provider Information | |||||||||
| NPI: | 1336221027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURVIS | ||||||||
| FirstName: | KATHY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S BEDFORD RD | ||||||||
| Address2: | MOUNT KISCO MEDICAL GROUP PC | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142323826 | ||||||||
| Practice Location | |||||||||
| Address1: | 192 ROUTE 117 BYPASS RD | ||||||||
| Address2: | MOUNT KISCO MEDICAL GROUP PC | ||||||||
| City: | BEDFORD HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105072146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142323826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 08/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 222455 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 02288815 | 05 | NY | MEDICAID | 0667910001 | 01 | NY | DME | OTHER |