Provider Demographics
NPI:1700869294
Name:BELSITO, DONALD VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:VINCENT
Last Name:BELSITO
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 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-5293
Mailing Address - Fax:212-305-2840
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-5293
Practice Address - Fax:212-795-1859
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425168207N00000X
NY137939207N00000X
NY137939-2207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00456765OtherRR MEDICARE
P00456765OtherRR MEDICARE
KSS799539Medicare ID - Type Unspecified