Provider Demographics
NPI:1053477448
Name:GERIATRIC MEDICAL SERVICE, PLLC
Entity Type:Organization
Organization Name:GERIATRIC MEDICAL SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-202-2686
Mailing Address - Street 1:900 MIDLAND AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1070
Mailing Address - Country:US
Mailing Address - Phone:914-202-2686
Mailing Address - Fax:914-202-2687
Practice Address - Street 1:1 WARTBURG PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3821
Practice Address - Country:US
Practice Address - Phone:914-699-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212150-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX201Medicare ID - Type Unspecified