Healthcare Provider Details

I. General information

NPI: 1396529442
Provider Name (Legal Business Name): WHITE PLAINS PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 E POST RD
WHITE PLAINS NY
10601-5008
US

IV. Provider business mailing address

PO BOX 412931
BOSTON MA
02241-2931
US

V. Phone/Fax

Practice location:
  • Phone: 914-849-3488
  • Fax:
Mailing address:
  • Phone: 844-363-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J PALUMBO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 914-681-1210