1477223824 NPI number — ONE SOURCE INFUSION CENTER LLC

Table of content: (NPI 1477223824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477223824 NPI number — ONE SOURCE INFUSION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE SOURCE INFUSION CENTER LLC
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:
1477223824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 E POST RD
Provider Second Line Business Mailing Address:
INFUSION SUITES
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10601-4606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-269-8580
Provider Business Mailing Address Fax Number:
914-287-2417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 E POST RD
Provider Second Line Business Practice Location Address:
INFUSION SUITES
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-269-8580
Provider Business Practice Location Address Fax Number:
914-287-2417
Provider Enumeration Date:
09/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUDDHAVARAPU
Authorized Official First Name:
RAJASEKHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
914-468-6084

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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