Healthcare Provider Details

I. General information

NPI: 1083755920
Provider Name (Legal Business Name): FORME MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7-11 S BROADWAY STE 100
WHITE PLAINS NY
10601-3520
US

IV. Provider business mailing address

7-11 S BROADWAY STE 100
WHITE PLAINS NY
10601-3520
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-4900
  • Fax: 914-448-5275
Mailing address:
  • Phone: 914-723-4900
  • Fax: 914-902-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5947200R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number5947200R
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number5947200R
License Number StateNY

VIII. Authorized Official

Name: MS. GINA CAPPELLI
Title or Position: PRESIDENT
Credential:
Phone: 914-723-4900