Provider Demographics
NPI:1891719902
Name:KAVESTEEN, DAVID E (MD FACC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:KAVESTEEN
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1619
Mailing Address - Country:US
Mailing Address - Phone:631-482-1355
Mailing Address - Fax:631-482-1356
Practice Address - Street 1:1350 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1619
Practice Address - Country:US
Practice Address - Phone:631-482-1355
Practice Address - Fax:631-482-1356
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215374207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH32122Medicare UPIN
359K11Medicare ID - Type Unspecified