Provider Demographics
NPI:1174962757
Name:DEGEN, MICHAEL CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CONRAD
Last Name:DEGEN
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 1:86 CREST DR
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4306
Mailing Address - Country:US
Mailing Address - Phone:917-974-7191
Mailing Address - Fax:
Practice Address - Street 1:86 CREST DR
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4306
Practice Address - Country:US
Practice Address - Phone:917-974-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262178208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology