Provider Demographics
NPI:1306976337
Name:NEPHROLOGY &HYPERTENSION SPECIALIST OF WESTCHESTER, PC
Entity type:Organization
Organization Name:NEPHROLOGY &HYPERTENSION SPECIALIST OF WESTCHESTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-969-3635
Mailing Address - Street 1:970 N BROADWAY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1309
Mailing Address - Country:US
Mailing Address - Phone:914-969-3635
Mailing Address - Fax:914-969-0407
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:SUITE 311
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-969-3635
Practice Address - Fax:914-969-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW14761Medicare ID - Type Unspecified