Provider Demographics
NPI:1275662611
Name:DE MEO, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:DE MEO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:311 E 72ND ST
Mailing Address - Street 2:SUITE# 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4684
Mailing Address - Country:US
Mailing Address - Phone:212-535-2599
Mailing Address - Fax:212-535-2598
Practice Address - Street 1:311 E 72ND ST
Practice Address - Street 2:SUITE# 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4684
Practice Address - Country:US
Practice Address - Phone:212-535-2599
Practice Address - Fax:212-535-2598
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY155918-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
155918-1OtherNYS LICENSE NUMBER
155918-1OtherNYS LICENSE NUMBER