Basic Information
| Provider Information | |||||||||
| NPI: | 1750319224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT KISCO MEDICAL GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | MT. KISCO MEDICAL GROUP, PC | ||||||||
| Address2: | 90 SOUTH BEDFORD ROAD | ||||||||
| City: | MT. KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | NORTHERN WESTCHESTER HOSPITAL CENTER | ||||||||
| Address2: | 400 EAST MAIN STREET | ||||||||
| City: | MT. KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661200 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | ABE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9142421587 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N/A | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.