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General NPI Number Information
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NPI Number | 1326208216
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Entity Type | Organization
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Legal Business Name | DEVITO INTERNAL MEDICINE AND PEDIATRICS LLC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 180 WHITE RD SUITE 205
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1166
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Country | US
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Telephone | 111-111-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 180 WHITE ROAD SUITE 205
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City | LITTLE SILVER
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State | NJ
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Zip | 07739
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Country | US
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Telephone | 111-111-1111
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARC JOSEPH DEVITO
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Credential | M.D.
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Telephone | 111-111-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA08232300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08232300
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License Number State | NJ
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