Healthcare Provider Details

I. General information

NPI: 1700869294
Provider Name (Legal Business Name): DONALD VINCENT BELSITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE FL 12
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE 12TH FLOOR
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5293
  • Fax: 212-795-1859
Mailing address:
  • Phone: 212-305-5293
  • Fax: 212-305-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0425168
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number137939
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number137939-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: