Healthcare Provider Details

I. General information

NPI: 1386131613
Provider Name (Legal Business Name): ENEA D HIMI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

256 MASON AVE FL 3
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 187-260-9000
  • Fax:
Mailing address:
  • Phone: 718-260-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number32161601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: