Provider Demographics
NPI:1487609889
Name:EMERGENCY MEDICAL OF WESTCHESTER PC
Entity type:Organization
Organization Name:EMERGENCY MEDICAL OF WESTCHESTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-740-0607
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:973-740-9895
Practice Address - Street 1:95 GRASSLANDS ROAD
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7000
Practice Address - Fax:973-740-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAW131Medicare ID - Type Unspecified