Provider Demographics
NPI:1275841637
Name:GERIATRIC MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:GERIATRIC MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-505-6142
Mailing Address - Street 1:445 HAMILTON AVE
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1807
Mailing Address - Country:US
Mailing Address - Phone:914-505-6142
Mailing Address - Fax:914-560-2108
Practice Address - Street 1:445 HAMILTON AVE
Practice Address - Street 2:SUITE 1102
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1807
Practice Address - Country:US
Practice Address - Phone:914-220-8386
Practice Address - Fax:914-740-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229470207QG0300X
207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03146687Medicaid
I19250Medicare UPIN