Provider Demographics
NPI:1497159560
Name:DIVINITY MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:DIVINITY MEDICAL SERVICES PLLC
Other - Org Name:DOCTORS EXPRESS YORKTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-930-5550
Mailing Address - Street 1:3091 CHEN CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1972
Mailing Address - Country:US
Mailing Address - Phone:914-844-9803
Mailing Address - Fax:914-930-5551
Practice Address - Street 1:3379 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-3605
Practice Address - Country:US
Practice Address - Phone:914-844-9803
Practice Address - Fax:914-930-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197245261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749875Medicaid
NY1902891393OtherNPI
NY1902891393OtherNPI