Provider Demographics
NPI:1669698841
Name:CAMACHO, JOSE (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S BROADWAY STE 406
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4413
Mailing Address - Country:US
Mailing Address - Phone:212-966-6655
Mailing Address - Fax:914-304-4223
Practice Address - Street 1:75 S BROADWAY STE 406
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4413
Practice Address - Country:US
Practice Address - Phone:212-966-6655
Practice Address - Fax:914-304-4223
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7761207Q00000X
NY278394207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine