Basic Information
| Provider Information | |||||||||
| NPI: | 1447255153 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHITE PLAINS HOSPITAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHITE PLAINS HOSPITAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 E POST ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
| FaxNumber: | 9146812839 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 E POST ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
| FaxNumber: | 9146812839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PALUMBO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9146811158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 282N00000X | 5902001H | NY | N | Hospitals | General Acute Care Hospital | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00274222 | 05 | NY | MEDICAID | 1000017877 | 01 | NY | AFFINITY | OTHER | H03134 | 01 | NY | OXFORD PROVIDER NUMBER | OTHER | 0060311 | 01 | NY | AETNA PROVIDER ID | OTHER | 0918822 | 05 | FL | MEDICAID | 710605 | 01 | NY | MOHAWK VALLEY PLAN | OTHER | IB0007 | 01 | NY | HEALTHNET PROVIDER ID | OTHER | 212700 | 01 | NY | BEACON HEALTH | OTHER | 000117 | 01 | NY | EMPIRE BLUE CROSS ID | OTHER | 100051 | 01 | NY | WELLCARE | OTHER |