Basic Information
| Provider Information | |||||||||
| NPI: | 1255386561 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRIC SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143765555 | ||||||||
| FaxNumber: | 9149641477 | ||||||||
| Practice Location | |||||||||
| Address1: | 69 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143765555 | ||||||||
| FaxNumber: | 9149641477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | KALCHTHALER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO AND MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9143765555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363A00000X | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207R00000X | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01060113 | 05 | NY | MEDICAID |