Provider Demographics
NPI:1134215403
Name:DAVIS, ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:DAVIS
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 1:2157 TOMLINSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1201
Mailing Address - Country:US
Mailing Address - Phone:718-822-0005
Mailing Address - Fax:718-822-6689
Practice Address - Street 1:2157 TOMLINSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1201
Practice Address - Country:US
Practice Address - Phone:718-822-0005
Practice Address - Fax:718-822-6689
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine