Provider Demographics
NPI:1427147099
Name:SOUTHERN WESTCHESTER DERMATOLOGY PC
Entity type:Organization
Organization Name:SOUTHERN WESTCHESTER DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:DONNA
Authorized Official - Last Name:TEPLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-9100
Mailing Address - Street 1:1 ELM STREET
Mailing Address - Street 2:PARKWAY PLAZA MEDICAL CENTER SUITE 2B
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707
Mailing Address - Country:US
Mailing Address - Phone:914-337-9100
Mailing Address - Fax:914-337-9485
Practice Address - Street 1:1 ELM STREET
Practice Address - Street 2:PARKWAY PLAZA MEDICAL CENTER SUITE 2B
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707
Practice Address - Country:US
Practice Address - Phone:914-337-9100
Practice Address - Fax:914-337-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1564121207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64895Medicare UPIN
NY93D731Medicare PIN