NPI 1376141325 · live from the CMS NPI Registry
369 Medical Practice PC
Physical Medicine & Rehabilitation in Eastchester, NY. National Provider Identifier 1376141325, active.
NPI record
| NPI | 1376141325 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physical Medicine & Rehabilitation 208100000X |
| Practice location | 369 White Plains Rd Fl 2, Eastchester, NY 10709 |
| Practice phone | 914-395-3691 |
| Mailing address | 369 White Plains Rd, Eastchester, NY 10709 |
| Enumerated | October 13, 2020 |
| Last updated | October 17, 2023 |
| Authorized official | Mack Sullivan, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | — |
| Physical Medicine & Rehabilitation primary | 208100000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.