Healthcare Provider Details

I. General information

NPI: 1699342964
Provider Name (Legal Business Name): TROCON DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 3RD AVE
NEW YORK NY
10021-5102
US

IV. Provider business mailing address

1198 3RD AVE
NEW YORK NY
10021-5102
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-4553
  • Fax:
Mailing address:
  • Phone: 212-759-4553
  • Fax: 212-486-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number336435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: