Provider Demographics
NPI:1861471740
Name:WHITE PLAINS MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:WHITE PLAINS MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WENGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-948-0500
Mailing Address - Street 1:56 DOYER AVE
Mailing Address - Street 2:SUITE 1-EF
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1639
Mailing Address - Country:US
Mailing Address - Phone:914-948-0500
Mailing Address - Fax:914-948-0560
Practice Address - Street 1:56 DOYER AVE
Practice Address - Street 2:SUITE 1-EF
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1639
Practice Address - Country:US
Practice Address - Phone:914-948-0500
Practice Address - Fax:914-948-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW15761Medicare PIN