Provider Demographics
NPI:1063580249
Name:SLEEPY HOLLOW MEDICAL GROUP@PHELPS
Entity type:Organization
Organization Name:SLEEPY HOLLOW MEDICAL GROUP@PHELPS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:914-631-0337
Mailing Address - Street 1:755 N BROADWAY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1075
Mailing Address - Country:US
Mailing Address - Phone:914-631-0337
Mailing Address - Fax:914-631-0552
Practice Address - Street 1:755 N BROADWAY
Practice Address - Street 2:SUITE 560
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1075
Practice Address - Country:US
Practice Address - Phone:914-631-0337
Practice Address - Fax:914-631-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01640528Medicaid
NYW5H942Medicare ID - Type Unspecified
NYW5H941Medicare ID - Type Unspecified