MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC NPI 1922525781

NPI Information

NPI: 1922525781
Provider Name: MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
384 E 149TH ST
BRONX, NY
ZIP 10455
Phone: (718) 301-1100
Get Directions

MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC is a vascular surgery surgery in Bronx, NY. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC NPI is 1922525781. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

384 E 149TH ST
BRONX, NY
ZIP 10455-908
Phone: (718) 301-1100
Fax: (224) 246-8042

The provider's authorized official is Yan Katsnelson .
The authorized official title is Ceo and has the following contact phone number (847) 257-1244.

The enumeration date for this NPI number is 8/23/2017 and was last updated on 3/26/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	265506	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	036105104	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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