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Organization

IRA DAVIS, MD, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. WENDY MANN (BILLER)
(914) 774-2478
Entity
Organization

Contact information

Practice address
2627 HYLAN BLVD # C, BOX 10, STATEN ISLAND, NY 10314
(718) 477-4022
(718) 698-9573
Mailing address
280 N CENTRAL AVE, SUITE 114, HARTSDALE, NY 10530-1832
(914) 288-0500
(914) 288-0260

Taxonomy

Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
182268
NY
207NS0135X
Procedural Dermatology Physician
182268
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3K2111
BC
NY
01
OH4223
HEALTHNET
NY
01
P00221021
RR MCR
NY
01
P2869871
OXFORD ID#
NY
Enumeration date
03/05/2007
Last updated
07/24/2015
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