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Organization

MOTT HAVEN PROFESSIONAL MEDICAL OF NEW YORK LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
YAN KATSNELSON MD (CEO)
(847) 257-1244
Entity
Organization

Contact information

Practice address
384 E 149TH ST, BRONX, NY 10455-3908
(718) 301-1100
(224) 246-8042
Mailing address
304 WAINWRIGHT DR, NORTHBROOK, IL 60062-1900
(847) 257-1244
(224) 246-8042

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
265506
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036105104
IL
Enumeration date
08/23/2017
Last updated
03/26/2018
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