Healthcare Provider Details

I. General information

NPI: 1669698841
Provider Name (Legal Business Name): JOSE CAMACHO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S BROADWAY STE 406
WHITE PLAINS NY
10601-4413
US

IV. Provider business mailing address

75 S BROADWAY STE 406
WHITE PLAINS NY
10601-4413
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-6655
  • Fax: 914-304-4223
Mailing address:
  • Phone: 212-966-6655
  • Fax: 914-304-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7761
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number278394
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number278394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: