Provider Demographics
NPI:1255386561
Name:GERIATRIC SERVICES, P.C.
Entity type:Organization
Organization Name:GERIATRIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALCHTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-376-5555
Mailing Address - Street 1:69 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4004
Mailing Address - Country:US
Mailing Address - Phone:914-376-5555
Mailing Address - Fax:914-964-1477
Practice Address - Street 1:69 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4004
Practice Address - Country:US
Practice Address - Phone:914-376-5555
Practice Address - Fax:914-964-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X, 363L00000X, 363A00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01060113Medicaid
NY01060113Medicaid