Basic Information
| Provider Information | |||||||||
| NPI: | 1023356912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOMERS ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 664 STONELEIGH AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105123940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452788400 | ||||||||
| FaxNumber: | 8452784320 | ||||||||
| Practice Location | |||||||||
| Address1: | 667 STONELEIGH AVE | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105122454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452305178 | ||||||||
| FaxNumber: | 8453631816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUCHALTER | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8452788400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.