Provider Demographics
NPI:1558337360
Name:DEVITO, JOSEPH SALVATORE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SALVATORE
Last Name:DEVITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2303
Mailing Address - Country:US
Mailing Address - Phone:516-797-7474
Mailing Address - Fax:516-795-7919
Practice Address - Street 1:930 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2303
Practice Address - Country:US
Practice Address - Phone:516-797-7474
Practice Address - Fax:516-795-7919
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0018230OtherGHI PROVIDER NUMBER
NY0490220OtherUS HEALTH CARE
NY11369OtherVYTRA HEALTH PLANS
NY01208584Medicaid
NY431596NOtherCIGNA
NYAP537OtherOXFORD HEALTH PLANS
NMAG4773OtherAETNA
NY166535-1OtherHIP
NY2C5778OtherHEALTHNET
NY431596NOtherCIGNA
NY0490220OtherUS HEALTH CARE