# ROBERT C MICKATAVAGE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720093453
- **Authorized official:** MRS. JILL K SMITH MA (CONTROLLER)
- **Authorized official phone:** (203) 778-1381

## Contact information

- **Practice address:** 3020 WESTCHESTER AVENUE, \# 101, PURCHASE, NY 10577-2562
- **Practice address phone:** (914) 967-4400
- **Practice address fax:** (914) 967-6416
- **Mailing address:** 3020 WESTCHESTER AVENUE, \# 101, PURCHASE, NY 10577-2562
- **Mailing address phone:** (914) 967-4400
- **Mailing address fax:** (914) 967-6416

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 10/15/2007