1205031762 NPI number — FAMILY MEDICINE OF WESTCHESTER

Table of content: (NPI 1205031762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205031762 NPI number — FAMILY MEDICINE OF WESTCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MEDICINE OF WESTCHESTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205031762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 N BROADWAY
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-207-0004
Provider Business Mailing Address Fax Number:
914-965-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-207-0004
Provider Business Practice Location Address Fax Number:
914-965-0107
Provider Enumeration Date:
06/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHUMACEIRO
Authorized Official First Name:
ROLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
914-207-0004

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  191384 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000022031 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 380330P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00000082060 . This is a "GHI MEDICARE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: W2T7T1 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16829012 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: O694421 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5051X1 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: O164399 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C1432 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000019311 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01411710 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191384 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 191384 . This is a "LOCAL 1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4627593 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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