Healthcare Provider Details

I. General information

NPI: 1588636005
Provider Name (Legal Business Name): MICHAEL ANTHONY DEVITA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE ROOM 14-106
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 LENOX AVE ROOM 14-106
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-4693
  • Fax: 212-939-2263
Mailing address:
  • Phone: 212-939-4693
  • Fax: 212-939-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD042029E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number163396-0
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number049363
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number163396-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: