Provider Demographics
NPI:1023083078
Name:PROVET, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:PROVET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:215 LEXINGTON AVENUE
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-686-9015
Mailing Address - Fax:212-686-8607
Practice Address - Street 1:215 LEXINGTON AVENUE
Practice Address - Street 2:20TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-686-9015
Practice Address - Fax:212-686-8607
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY158675208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20362Medicare UPIN
NY19F001Medicare PIN