=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275841637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GERIATRIC MEDICAL ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2010
-----------------------------------------------------
Last Update Date | 10/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 HAMILTON AVE SUITE 1102
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-220-8386
-----------------------------------------------------
Fax | 914-740-7256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 HAMILTON AVE SUITE 1102
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-505-6142
-----------------------------------------------------
Fax | 914-560-2108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAUL CAVALUZZI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 914-505-6142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 229470
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------