Provider Demographics
NPI:1174617427
Name:FORREST, DAVID VICKERS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VICKERS
Last Name:FORREST
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 1:155 WEST 68TH STREET
Mailing Address - Street 2:SUITE 1219
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5818
Mailing Address - Country:US
Mailing Address - Phone:212-873-7750
Mailing Address - Fax:
Practice Address - Street 1:115 EAST 61ST STREET
Practice Address - Street 2:SUITE 8E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8185
Practice Address - Country:US
Practice Address - Phone:212-319-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0944032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17585Medicare UPIN