Healthcare Provider Details

I. General information

NPI: 1871515346
Provider Name (Legal Business Name): MICHAEL MARIANO SCIMECA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST 90TH ST. STE. 11H
NEW YORK NY
10024
US

IV. Provider business mailing address

200 W 90TH ST APT 11G
NEW YORK NY
10024-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-580-9605
  • Fax: 212-580-9792
Mailing address:
  • Phone: 212-877-3763
  • Fax: 212-580-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number138626
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number138626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: