Provider Demographics
NPI:1447331137
Name:NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC
Entity type:Organization
Organization Name:NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOWDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-249-7000
Mailing Address - Street 1:2900 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2552
Mailing Address - Country:US
Mailing Address - Phone:914-249-7000
Mailing Address - Fax:914-249-7034
Practice Address - Street 1:1500 ASTOR AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5900
Practice Address - Country:US
Practice Address - Phone:718-652-0003
Practice Address - Fax:718-652-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02736625005Medicaid
NYWCK261Medicare PIN
NY02736625005Medicaid