Organization Active NPI

Geriatric Medical Service of Westchester PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Ardsley, NY
National Provider Identifier
1174795280
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
187890 Issued in NY
Legal business name
GERIATRIC MEDICAL SERVICE OF WESTCHESTER PC
Practice address
11 Dellwood LN
Ardsley, NY 10502-1309
Phone
(914) 231-5725
NPI assigned
Mar 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Devang Dave, M.D.NPI 1487728317
Title
President
Phone
(914) 572-6128

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0300X 187890 NY Primary

Addresses

Primary practice location

11 Dellwood LN
Ardsley, NY 10502-1309

Mailing address

11 Dellwood LN
Ardsley, NY 10502-1309

Other identifiers 1

IdentifierTypeStateIssuer
02111306MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111128000865 NY Part B Supplier - Clinic/Group Practice 2365334273 Receives reassigned benefits from 1 practitioner
Practice locations: New Rochelle, NY; Mt Vernon, NY; Mount Vernon, NY; Flushing, NY; Ardsley, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1174795280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 DELLWOOD LN",
            "city": "ARDSLEY",
            "state": "NY",
            "postal_code": "105021309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 DELLWOOD LN",
            "city": "ARDSLEY",
            "state": "NY",
            "postal_code": "105021309",
            "telephone_number": "914-231-5725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC MEDICAL SERVICE OF WESTCHESTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "DAVE",
        "authorized_official_first_name": "DEVANG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-572-6128",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "187890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02111306",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardsley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.