Provider Demographics
NPI:1598859589
Name:FAVATE, ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:FAVATE
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 1:222 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6739
Mailing Address - Country:US
Mailing Address - Phone:212-263-7744
Mailing Address - Fax:212-263-7721
Practice Address - Street 1:222 E 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:212-263-7744
Practice Address - Fax:212-263-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1615832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3239454OtherOXFORD
2814995OtherAETNA HMO
6016100OtherGHI
161583OtherSTATE LICENSE
043695466OtherTAX ID
22621OtherELDERPLAN
3656599OtherAETNA
548N01OtherBCBS
NY01602400Medicaid
3C6334OtherHEALTHNET
4637585OtherAETNA PPO
548N02OtherBCBS
P00072195OtherRAILROAD MEDICARE
6016100OtherGHI
81F641Medicare ID - Type Unspecified