Provider Demographics
NPI:1104900109
Name:JAVIT, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:JAVIT
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:PO BOX 52788
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2788
Mailing Address - Country:US
Mailing Address - Phone:865-766-8800
Mailing Address - Fax:865-766-8874
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2685
Practice Address - Fax:212-434-2253
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1786562085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY702T81OtherEMPIRE BCBS
NJ6363601Medicaid
NY01496042Medicaid
NYF78038Medicare UPIN
NYDJ004J0310Medicare PIN
NY702T81OtherEMPIRE BCBS
NY01496042Medicaid
NYP00213772Medicare PIN