Healthcare Provider Details

I. General information

NPI: 1710008339
Provider Name (Legal Business Name): CHILD & FAMILY MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S BROADWAY STE 711
WHITE PLAINS NY
10601-4427
US

IV. Provider business mailing address

34 S BROADWAY STE 711
WHITE PLAINS NY
10601-4427
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-4700
  • Fax: 914-285-5723
Mailing address:
  • Phone: 914-946-4700
  • Fax: 914-285-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0147861
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number162541
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0137821
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0161771
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0549371
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0699861
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0736941
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1140581
License Number StateNY
# 9
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2268491
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAJ INAMDAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 212-725-0192