Organization
ROBERT C MICKATAVAGE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JILL K SMITH MA (CONTROLLER)
(203) 778-1381
Entity
Organization
Contact information
Practice address
3020 WESTCHESTER AVENUE, # 101, PURCHASE, NY 10577-2562
(914) 967-4400
(914) 967-6416
Mailing address
3020 WESTCHESTER AVENUE, # 101, PURCHASE, NY 10577-2562
(914) 967-4400
(914) 967-6416
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00565513
—
NY
Enumeration date
07/30/2006
Last updated
10/15/2007
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