Provider Demographics
NPI:1912216060
Name:ENDICOTT, NOBLE ASHWORTH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:ASHWORTH
Last Name:ENDICOTT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 W 246TH ST.
Mailing Address - Street 2:(APT 1203)
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-884-5012
Mailing Address - Fax:212-543-5386
Practice Address - Street 1:600 W 246TH ST.
Practice Address - Street 2:(APT 1203)
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-884-5012
Practice Address - Fax:212-543-5386
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0825962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry