Basic Information
| Provider Information | |||||||||
| NPI: | 1326208216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEVITO INTERNAL MEDICINE AND PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 WHITE ROAD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LITTLE SILVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 WHITE RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LITTLE SILVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077391166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEVITO | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 1111111111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08232300 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 25MA08232300 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.