Basic Information
| Provider Information | |||||||||
| NPI: | 1720713878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITE PLAINS PHYSICIAN SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412931 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146811210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 MAMARONECK AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105281635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147238100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | PALUMBO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9146811210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHITE PLAINS PHYSICIAN SERVICES, P.C. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | DMERC | 01 | NY | DMERC | OTHER |