Provider Demographics
NPI:1801806070
Name:DEVIVO, DARRYL C (MD)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:C
Last Name:DEVIVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-5244
Mailing Address - Fax:212-305-7036
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-5244
Practice Address - Fax:212-305-7036
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1369452084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00690515Medicaid