Provider Demographics
NPI:1205031762
Name:FAMILY MEDICINE OF WESTCHESTER
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF WESTCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUMACEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-207-0004
Mailing Address - Street 1:970 N BROADWAY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1309
Mailing Address - Country:US
Mailing Address - Phone:914-207-0004
Mailing Address - Fax:914-965-0107
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:SUITE 309
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-207-0004
Practice Address - Fax:914-965-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000022031OtherAFFINITY
NY380330POtherHIP
NYP00000082060OtherGHI MEDICARE CHOICE
NYW2T7T1OtherMEDICARE
NY16829012OtherCIGNA
NYO694421OtherAETNA HMO
NY5051X1OtherBC/BS
NYO164399OtherGHI PPO
NY6C1432OtherHEALTHNET
NY00000019311OtherGHI HMO
NY01411710Medicaid
NY191384OtherCONNECTICARE
NY191384OtherLOCAL 1199
NY4627593OtherAETNA
NY01411710Medicaid
NY191384OtherLOCAL 1199
NY380330POtherHIP
NY4627593OtherAETNA
NY6C1432OtherHEALTHNET
NY01411710Medicaid