=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205031762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICINE OF WESTCHESTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 N BROADWAY SUITE 309
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-207-0004
-----------------------------------------------------
Fax | 914-965-0107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 N BROADWAY SUITE 309
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-207-0004
-----------------------------------------------------
Fax | 914-965-0107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROLANDO CHUMACEIRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 914-207-0004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 191384
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------