Provider Demographics
NPI:1366599805
Name:ADDONIZIO, DEVON KIMBERLY (MD)
Entity type:Individual
Prefix:MS
First Name:DEVON
Middle Name:KIMBERLY
Last Name:ADDONIZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:165 EAST 89TH ST
Mailing Address - Street 2:#4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-369-3495
Mailing Address - Fax:212-717-5691
Practice Address - Street 1:1430 SECOND AVE
Practice Address - Street 2:STE 103 OUTPATIENT CENTER FOR MENTAL HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-434-2781
Practice Address - Fax:212-717-5691
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2270392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
434BM1Medicare ID - Type Unspecified
I19406Medicare UPIN