Healthcare Provider Details

I. General information

NPI: 1134695562
Provider Name (Legal Business Name): DAVIS AVENUE MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4607
US

IV. Provider business mailing address

41 E POST RD
WHITE PLAINS NY
10601-4607
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-1210
  • Fax: 914-681-2839
Mailing address:
  • Phone: 914-681-1210
  • Fax: 914-681-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J PALUMBO
Title or Position: CMO/SVP
Credential: MD
Phone: 914-681-1210