Individual
DR. ROBERT CHARLES MICKATAVAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3020 WESTCHESTER AVE, STE 101, PURCHASE, NY 10577
(914) 967-4400
(914) 967-6416
Mailing address
3020 WESTCHESTER AVE, STE 101, PURCHASE, NY 10577
(914) 967-4400
(914) 967-6416
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
092072
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00565513
—
NY
01
—
180037724
RAILROAD MC
—
01
—
WS1186
OXFORD
—
Enumeration date
07/28/2006
Last updated
09/29/2010
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