| 369 Medical Practice Pc | |
|
369 White Plains Rd Fl 2 Eastchester NY 10709-2805 | |
| (914) 395-3691 | |
| Not Available |
| Full Name | 369 Medical Practice Pc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 369 White Plains Rd Fl 2, Eastchester, New York |
| Authorized Official Name and Position | Mack Sullivan (OWNER) |
| Authorized Official Contact | 9143953691 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 369 Medical Practice Pc 369 White Plains Rd Eastchester NY 10709-2805 Ph: (914) 369-3691 | 369 Medical Practice Pc 369 White Plains Rd Fl 2 Eastchester NY 10709-2805 Ph: (914) 395-3691 |
| NPI Number | 1376141325 |
|---|---|
| Provider Enumeration Date | 10/13/2020 |
| Last Update Date | 10/17/2023 |
| Medicare PECOS PAC ID | 5496155376 |
|---|---|
| Medicare Enrollment ID | O20210615000800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376141325 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Mack L Sullivan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881616068 PECOS PAC ID: 5698764314 Enrollment ID: I20040508000152 |
| Provider Name | Richard R Serrano |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588729636 PECOS PAC ID: 2961574017 Enrollment ID: I20080707000153 |
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