Healthcare Provider Details

I. General information

NPI: 1164878690
Provider Name (Legal Business Name): DR. ANTONIO J CONVIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 32ND ST 8TH FLOOR
NEW YORK NY
10016-6055
US

IV. Provider business mailing address

145 E 32ND ST 8TH FLOOR
NEW YORK NY
10016-6055
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7565
  • Fax:
Mailing address:
  • Phone: 212-263-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number146661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: