Basic Information
| Provider Information | |||||||||
| NPI: | 1689955338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE PLAINS MEDICAL DIAGNOSTIC SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2011 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | PALUMBO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICIER | ||||||||
| AuthorizedOfficialTelephone: | 9146811201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | TF2961893 | 01 | NY | TAX FRANCHISE | OTHER |