Provider Demographics
NPI:1477223824
Name:ONE SOURCE INFUSION CENTER LLC
Entity Type:Organization
Organization Name:ONE SOURCE INFUSION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJASEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDDHAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-468-6084
Mailing Address - Street 1:44 E POST RD
Mailing Address - Street 2:INFUSION SUITES
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4606
Mailing Address - Country:US
Mailing Address - Phone:914-269-8580
Mailing Address - Fax:914-287-2417
Practice Address - Street 1:44 E POST RD
Practice Address - Street 2:INFUSION SUITES
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4606
Practice Address - Country:US
Practice Address - Phone:914-269-8580
Practice Address - Fax:914-287-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain