Provider Demographics
NPI:1871515346
Name:SCIMECA, MICHAEL MARIANO (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARIANO
Last Name:SCIMECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W 90TH ST APT 11G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1236
Mailing Address - Country:US
Mailing Address - Phone:212-877-3763
Mailing Address - Fax:212-580-9792
Practice Address - Street 1:200 WEST 90TH ST.
Practice Address - Street 2:STE. 11H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-580-9605
Practice Address - Fax:212-580-9792
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1386262084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY73A61Medicare ID - Type UnspecifiedMEDICINE (PSYCHIATRY)
NYB19081Medicare UPIN