Provider Demographics
NPI:1306149778
Name:FAVATE NEUROLOGY PC
Entity type:Organization
Organization Name:FAVATE NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-675-3878
Mailing Address - Street 1:80 FIFTH AVENUE SUITE 1605
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-675-3878
Mailing Address - Fax:212-647-1931
Practice Address - Street 1:80 FIFTH AVENUE SUITE 1605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-675-3878
Practice Address - Fax:212-647-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1615832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3239454OtherOXFORD
NY01602400Medicaid
7C6669OtherHEALTHNET
NY4637585OtherAETNA PPO
NY01602400Medicaid