Provider Demographics
NPI:1215003629
Name:MASSIMO DEGIARDE, M.D.,P.C.
Entity Type:Organization
Organization Name:MASSIMO DEGIARDE, M.D.,P.C.
Other - Org Name:LAFAYETTE MEDICAL APPROACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:212-966-7193
Mailing Address - Street 1:233 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4051
Mailing Address - Country:US
Mailing Address - Phone:212-431-6177
Mailing Address - Fax:212-966-7160
Practice Address - Street 1:233 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4051
Practice Address - Country:US
Practice Address - Phone:212-431-6177
Practice Address - Fax:212-966-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070710386261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00166849Medicaid