Healthcare Provider Details

I. General information

NPI: 1861471740
Provider Name (Legal Business Name): WHITE PLAINS MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 DOYER AVE SUITE 1-EF
WHITE PLAINS NY
10605-1639
US

IV. Provider business mailing address

56 DOYER AVE SUITE 1-EF
WHITE PLAINS NY
10605-1639
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-0500
  • Fax: 914-948-0560
Mailing address:
  • Phone: 914-948-0500
  • Fax: 914-948-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRY D WENGLIN
Title or Position: SHAREHOLDER
Credential: MD
Phone: 914-948-0500