Organization Name: | TINA DISCEPOLA MEDICAL, PC |
NPI Number: | 1538456355 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CONSTANTINA DISCEPOLA (PRESIDENT/OWNER) |
Mailing Address: | 1034 N Broadway Family Medicine Of Westchester Yonkers |
State: | NY US |
Postal Code: | 107011328 |
Phone Number: | 9149092546 |
Fax Number: | 9149092546 |
NPI Enumeration Date: | 06/30/2011 |
NPI Last Update Date: | 06/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 192494 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |