Provider Demographics
NPI:1194954339
Name:WESTCHESTER PUTNAM UROLOGY, LLP
Entity type:Organization
Organization Name:WESTCHESTER PUTNAM UROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:CP
Authorized Official - Last Name:FAVALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-739-1219
Mailing Address - Street 1:1985 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4146
Mailing Address - Country:US
Mailing Address - Phone:914-739-1219
Mailing Address - Fax:914-739-2353
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-739-1219
Practice Address - Fax:914-739-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty