Provider Demographics
NPI:1427152040
Name:ETTENGER, NORMAN ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ARTHUR
Last Name:ETTENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GEDNEY ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3513
Mailing Address - Country:US
Mailing Address - Phone:914-997-6949
Mailing Address - Fax:
Practice Address - Street 1:130 WEST KINGSBRIDGE ROAD
Practice Address - Street 2:JAMES J PETERS VA MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12444312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology